Scrotal emergency (Acute scrotum) Flashcards
What are some forms of scrotal emergency?
- Torsion of spermatic cord
- Torsion of appendix testis
- Epididymitis/epididymo-orchitis
- Inguinal hernia
- Hydrocoele
- Trauma/insect bite
- Dermatological lesions
- Inflammatory vasculitis
- Tumour
When is torsion of the spermatic cord most common?
Most common at puberty/teenage
What causes torsion of the spermatic cord?
Can occur with trauma or athlectic activity but is usually spontaneous
What anatomical anomaly can predispose to torsion of the spermatic cord?
Bell clapper deformity
What is meant by torsion of the spermatic cord?
Occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum
How can bell clapper deformity predispose to torsion of the spermatic cord?
insertion of the tunica vaginalis is high, meaning testis can rotate and even sit laterally
How will torsion of the spermatic cord present?
- Sudden, severe, testicular pain (in the groin and lower abdomen) and tenderness
- There is often associated nausea and vomiting
- The testis may be higher than its normal position
- Mild pyrexia and redness of overlying area may be found
- The cremasteric reflex is often reduced or absent
- Possible acute hydrocoele and oedema which may obliterate landmarks
What investigation may be useful in torsion of the spermatic cord?
Dopler USS
How is torsion of the spermatic cord managed?
- Prompt exploration
- Surgery - 2-3 point fixation with fine, non-absorbable sutures
- Fix contralateral side
Why is a necrotic testicle usually removed in surgery?
This is because necrosis will cause breakdown of the blood-testes barrier, which allows antibodies to form against testes tissue, and so the body will begin to attack the healthy testis
What is the testicular appendage?
The appendage is a normal but defunct piece of tissue after birth, found in around 80% of males
What is the range of symptoms in torsion of the appendage?
ranging from insidious onset of pain to similar symptoms to torsion of the cord
What is an early sign of torsion of the appendage?
localised tenderness at the upper pole and a “Blue-dot sign” in the testes, which is the appendage
What is the cremasteric reflex?
When the inner part of the thigh is touched, the ipsilateral testicle will rescind to protect from danger
How is torsion of the appendage managed?
Resolves spontaneously without surgery
What is epididymoorchitis?
Inflammation of the testis and epididymis secondary to infection
What is the most common cause of epidiymoorchitis in those under 35?
STIs (E.g. Gonorrhoea)
What is the most common cause of epididymoorchitis in those over 35?
E. coli- originating from the GI tract
How will epididymoorchitis present?
- Acute onset, severe testicular pain
- Patient may feel unwell and have a history of dysuria and urethral discharge (due to an STI)
What are some signs of epididymoorchitis on examination?
- testis is warm, red, hot and swollen and is tender to touch
- The classic finding on testicular examination that supports epidydmo-orchitis is the alleviation of pain upon elevation of the testes
- Cremasteric reflex present and possible pyrexia
What investigations are required in epidydimoorchitis?
Doppler scan - Swollen epididymis and increased bloodflow
Send urine for cultures and chlamydia PCR
How is epididymoorchitis managed?
- Analgesia and antibiotics
- Ofloxacin 400mg/day for 14 days
What is idiopathic scrotal oedema?
This is a self-limiting condition of unknown cause, not usually associated with scrotal erythema or fever
There may be minimal tenderness and possible pruritis
