Scrotal Swellings

Dr. Vivek Rege
Differentiating Testicular Torsion And Epididymo Orchitis (eo)
Differentiating the two is very difficult clinically. However, a detailed history with a proper examination may help if the child allows. Usually, a small child with severe pain will scream just looking at the doctor and examination will not be possible very easily. Some of the things that may help during examination are - check if there is more swelling posteriorly with thickening of the epididymis, suggestive of EO. At times the pain is not very severe and gradually supporting and lifting the epididymis with the palm of the hand may give relief to the child again a sign of inflammation. Another clinical sign that may help is eliciting the Cremasteric reflex by stroking the medial side of the upper thigh. If this results in a positive reflex, the testis gets pulled upwards due to the contraction of the cremaster muscle, it means that the cremaster can function as it is not twisted. Thus, positive cremasteric reflex, usually rules out torsion. On the other hand absence of the reflex does not necessarily mean only torsion as the inflammation and edema due to the infection can temporarily make the cremaster inactive. Thus there is no active and definitive method of clinically differentiating one from the other.

There is one investigation that may help to a certain extent. A Color Doppler study for the blood supply to the testis will show no blood flow in case of Torsion but excess blood flow in EO. However, this is based on many factors like, the person doing the study (experience). The time from onset when the study is done, after 6-9 hours, there is an excess blood flow around the testicular region and could be mistaken for EO and the boy is conserved with poor result and the testis is atrophic and functionless later in life.

Inguinal Swellings

Scrotal Swellings Scrotal Swellings 03/01/2005
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