Acute scrotal pain in a 5 years old child


Scrotal pain has to be assessed and carefully taken into consideration in order to rule out an acute testicular torsion

At 11 pm the doctor on duty in the E.R. at my hospital called me because suspected a testicular torsion on 5 y/o child. His mother and father took him to the hospital because of right testicular pain which started in the morning after playing with his friends and became severe in the evening.

After the phone call, I was in doubt about a testicular torsion because of: 

1) the age of the patient it is not typical. The testicular torsion, in fact, is more common in the puberty or immediately after in the young adult, when the testis has grown and the torsion is easier the ligaments are not developed.

2) the main cause of scrotal pain in this age range is the torsion of the small appendix of the testis or the epididymis.

When I arrived and I saw the patient quietly sleeping after receiving a small dose of paracetamol, I was sure that I hadn't been dealing with an acute testicular torsion. I've never seen a patient sleeping despite an acute testicular torsion. If there is the case, the pain will be unbearable, it doesn't  respond to common painkillers, it is usually associated with nausea and vomiting as vagal symptoms.

During the physical examination, I could touch deeply the right testis without waking up the little patient. One of the most important signs of testicular torsion is a contracted testis which is firmly stuck in the root of the scrotum or sometimes even in the superficial inguinal area. Moreover, the complete absence of the cremasteric sensitive-motor nerve reflex and foremost the impossible examination of the testis are others important signs to rule out.

When in doubt, the Doppler Duplex Ultrasound is useful to check the vascular supplies of the testis and definitely confirm or rule out an ischemic suffer from the testis.

Dopper Duplex High-Frequency Ultrasound shows colored spots indicating a good vascular supply