Role of Doppler ultrasonography in acute scrotum in children and young adults

Abstract

Background: Objective: To evaluate the efficacy of Doppler ultrasound in correctly diagnosing acute scrotal conditions in children and young adults. Methods: Over a period of two years 50 patients with acute scrotum were admitted in general surgery department who underwent Doppler ultrasound scrotum and its efficacy in correctly diagnosing the pathology was analysed.   Results: 50 patients with age group ≤25 years were included in study. Scrotal pain was the most frequent presenting symptom of acute scrotum (98%) followed by Swelling of the hemiscrotum on the involved side present in 88% of the patients. Doppler ultrasound showed torsion of testis in 22 patients. On Scrotal exploration, torsion of spermatic cord was confirmed in 20 patients, one patient had torsion of appendix of testis and the other had Epididymo-orchitis. Thus the sensitivity and specificity of Doppler ultrasonography for testicular torsion was 86.9% and 92.6% respectively.  Three patients with equivocal Doppler findings, but strong clinical suspicion of testicular torsion were explored, and testis was found to be torsed in all the three patients. Doppler ultrasonography showed Epididymo-orchitis in 20 patients, torsion of testicular appendage in 2 patients, Idiopathic scrotal edema in one, Incarcerated inguinal hernia in one, and a large hematocele in one patient. All twenty patients of epididymo-orchitis, two patients of torsion of testicular appendage, and one patient of idiopathic scrotal edema were managed conservatively. At three weeks follow up, all the patients were free of symptoms. One patient of scrotal trauma with Doppler showing a large hematocele, and the other one with obstructed inguinal hernia were explored and Doppler findings were confirmed. The sensitivity and specificity of Doppler ultrasonography for epididymo-orchitis was 95% and 100% respectively. Conclusions: Doppler ultrasound scrotum is an important investigation in acute scrotum.