Education And Debate

ABC of General Surgery in Children: ACUTE PROBLEMS OF THE SCROTUM

BMJ 1996; 312 doi: (Published 17 February 1996) Cite this as: BMJ 1996;312:435
  1. Mark Davenport

    An “acute scrotum” is a common presentation in infants and children with several possible causes, some of which require immediate corrective surgery while others may need only reassurance. It is helpful to consider the possibilities by the age of the child, as knowledge of this can lead in many cases to the most likely diagnosis.

    Incidence of common causes of acute scrotal problems in infants and children.

    Acute problems in newborn infants

    The likeliest cause in a newborn infant is testicular torsion or trauma, usually due to a breech delivery.

    In infants an irreducible inguinal

    hernia may mimic an acute scrotal


    Testicular torsion

    A testicular torsion in newborn infants differs anatomically from that in older boys because it is a twist of the whole spermatic cord, and presumably occurs because of the unfixed nature of the newly descended testis. Almost all of such torsions present late—at the stage of overt testicular necrosis. Pain and tenderness are not prominent features in newborn infants. The scrotum is usually red and swollen and contains a hard testicular mass.

    Surgery is required, but usually only to excise an irretrievably damaged organ. Most surgeons would also fix the other testis, as cases of bilateral torsion have occasionally been reported.

    Scrotal bruising due to idiopathic haemorrhage in a 3 day old infant.


    A similar appearance can follow a difficult breech delivery, although the swelling usually affects both sides and cutaneous bruising may be more prominent. Most cases resolve spontaneously, but progress should be monitored. Spontaneous idiopathic scrotal haemorrhage has been reported in normally delivered infants, though they are usually large for their …

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