| Abstract | Cilj istraživanja: Akutni skrotum je klinički sindrom uzrokovan nizom stanja i bolesti, a karakteriziran je bolnim otokom i crvenilom skrotuma. Najčešći uzroci akutnog skrotuma su torzija testisa, akutni epididimitis i torzija testikularnih privjesaka (hydatida Morgagni). Diferencijalna dijagnoza uzroka akutnog skrotuma je od velike kliničke važnosti u svakodnevnoj praksi. Ukoliko torzija testisa nije na vrijeme prepoznata, posljedice za testis djeteta mogu biti pogubne. Cilj ovog rada bio je analizirati postupke i ishod liječenja u bolesnika s akutnim skrotumom. Ispitanici i metode: U vremenskom razdoblju od siječnja 1991. do lipnja 2014. retrospektivno su pregledane povijesti bolesti 558 bolesnika operirana zbog akutnog skrotuma. Podatke smo prikupili istraživanjem pisanog protokola Odjela za dječju kirurgiju Kliničkog Bolničkog Centra Split te arhive povijesti bolesti. Svakom ispitaniku su analizirani sljedeći parametri: anamnestički podaci o početku i lokalizaciji bolova, fizikalni pregled, operacijski nalaz i rezultati praćenja, dob, etiologija, te vrijeme koje je bilo potrebno da bolesnik, od nastanka ozljede dođe do bolnice.
Rezultati: Istraživanje je obuhvatilo 558 bolesnika, srednje dobi 12 godina operiranih zbog akutnog skrotuma. Od toga je bilo 142 (25%) torzije testisa, 344 (62%) torzije hydatidae Morgagni, 54 (10%) epididimitisa, 10 (2%) testikularnih trauma i 8 (1%) bolesnika operiranih zbog ostalih uzroka. Nađena su dva vrška učestalosti za torziju testisa, prvi tijekom prve godine života i drugi između 13 i 15 godine života. Učestalost torzije hydatidae Morgagni je najveća u 11 godini života, dok je epididimitis najčešći u prvoj godini života. Lijevi testis bio je zahvaćen u 304 bolesnika (54%), a desni u 254 bolesnika (46%). U bolesnika s torzijom testisa srednje vrijeme trajanja simptoma u skupini bolesnika u kojih je testis spašen bilo je 6 sata, dok je u skupini bolesnika u kojih je učinjena orhidektomija iznosilo 46 sati. Nije zabilježeno značajnijih komplikacija. Prosječno vrijeme trajanja simptoma do javljanja u bolnicu bilo je 6 sati u skupini bolesnika s torzijom testisa, 24 sata kod torzije hydatidae Morgagni, 12 sati kod epididimitisa, 35 sati kod testikularne traume te 12 sati kod ostalih uzroka. Akutni skrotum značajno je češći u zimskim mjesecima. Torzija testisa ima najveću učestalost u siječnju i kolovozu. Zaključci: Rana eksploracija skrotuma zasnovana na pažljivom fizikalnom pregledu isključuje rizik od pogrešne dijagnoze i nepotrebnog odugovlačenja sa dijagnostičkim sredstvima. Neovisno o etiologiji skrotalne boli, od velike je važnosti da bolesnik potraži hitnu medicinsku pomoć. Ukoliko je bolesnik došao na vrijeme, unutar 6 sati od nastanka simptoma, testis može biti spašen. |
| Abstract (english) | Objectives and background: Acute scrotum is a clinical syndrome caused by a number of conditions, and is characterized by painful swelling and redness of the scrotum. The most common causes of acute scrotum in clinical practice are testicular torsion, acute epididymitis, and torsion of testicular pendants. The differential diagnosis of acute scrotum is of great clinical importance in everyday practice. If not recognized on time the testicle may be lost. The aim of this study was to analyze management and outcomes of treatment in patients with acute scrotum.
Patients and Methods: From January 1991 until June 2014 case records of 558 patients who underwent surgery for acute scrotum were retrospectively reviewed. Mean age was 12 years. Data were collected from archives of the Department of Pediatric Surgery, University Hospital Split. Each patient was analyzed for following parameters: history data at the start and localization of pain, physical examination, operating results and the results of follow-up, age, etiology, and the time from initial symptoms to surgery.
Results: The study included 558 patients who underwent surgery because of acute scrotum. There were 142 (25%) patients with testicular torsion, 344 (62%) torsion of hydatid Morgagni, 54 (10%) epididymitis, 10 (2%) testicular trauma and 8 (1%) patients under other causes. Two peaks of incidence of testicular torsion were found, the first during first year of life and the second between 13 and 15 years of life. The incidence of torsion of hydatid Morgagni was highest in 11 year of life, whereas epididymitis was most common in the first year of life. Left testicle was affected in 304 patients (54%), and the right in 254 patients (46%). In patients with testicular torsion, median duration of symptoms in the group of salvaged testes was 6 hours, while in the group of patients who underwent orchidectomy was 46 hours. There were no major complications. The average duration of symptoms was 6 hours in patients with testicular torsion, 24 hours for torsion of hydatid Morgagni, 12 hours for epididymitis, 35 hours for testicular trauma and 12 hours for other causes. Acute scrotum is significantly more common in the winter. Torsion of the testis has the highest incidence in January and August.
Conclusions: Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of testicular torsion. Regarding the etiology of scrotal pain it is of great importance that the patient seeks immediate medical attention. If the patient arrived on time, within 6 hours, the testicle can be saved. |
