The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

Objective: To describe the clinical presentation as well as the outcome of surgically explored acute scrotal swellings among children and adolescents recorded at the Al-Jahra Hospital, Kuwait during the period 1985–1995. Methods: Hospital records of 120 cases were reviewed. Results: Seventeen percent of the cases were found to be testicular torsions (TT) and 40% torsions of testicular appendages (TAT). Other etiologies included traumatic swelling (15%), idiopathic edema (13%), epididymo-orchitis (10%), hydroele (4%) and others (2%). Ages of patients ranged from 6 months to 18 years, averaging 9.3 years (SD = 2.9) for TAT cases and 10.1 years (SD = 6.4) for TT cases. Swelling and pain were located on the left side for 65% of the torsion cases. Direct trauma was reported in 22% of the torsion cases. In 90% of TT cases, orchidopexy was performed with success. Subsequent testicular atrophy occurred in only 1 patient who had symptoms for more than 48 h prior to surgery. Orchidectomy was directly performed on necrosed testes in a patient with signs lasting more than 48 h, and another patient with signs lasting 4 days. Conclusions: Primary health care physicians in Jahra district should continue to educate parents and adolescents to recognize the gravity of scrotal pain, and the importance of early response as a way of avoiding testicular necrosis.