The identification and differentiation methods of pediatric testicular emergencies are.
1, pediatric testicular adnexal torsion: pediatric testicular adnexal torsion is the main cause of pediatric testicular emergencies, pathological features are embryonic residual testicular adnexa or into pieces, spherical, flogging or single or several, mostly located on the sinus groove between the testis and adnexa or on the testis and epididymis, due to part of the base into the tip, the occurrence of torsion caused by ischemic necrosis of the transport end, resulting in a local ischemic inflammatory reaction spread to the epididymis, testis and adnexa.
The following features of this disease are noted.
(1) The disease occurs most often in school-aged children and rarely in children younger than 4 years old.
(2) Most have no obvious cause, some have a history of trauma, but causality cannot yet be proven.
(3) The time between onset and consultation is mostly between 1-2 hours, without systemic symptoms such as fever.
(4) The affected side of the adnexa is obviously edematous, the testes are enlarged, mostly accompanied by intrasphincteric exudate, the scrotum is diffusely swollen, and the spermatic cord and epididymis are mildly thickened and painful to the touch.
(5) Some children can see the “blue spot sign”, which is a reflection of the necrotic testicular adnexa through the edematous scrotal skin.
2, orchitis: pediatric orchitis most unilateral onset, occasionally bilateral or bilateral successive onset, due to the normal blood testicular barrier, testicular septic infection is rare, most of the viral infection inflammation, common mumps virus and other respiratory viruses.
The manifestations and characteristics of pediatric orchitis are.
(1) Most have a history of mumps or submandibular adenitis.
(2) Heavy systemic reaction, most with fever, temperature of 38.5°C or higher, flaccid or fever, blood count, and predominantly lymphocytic white blood cells.
(3) Slow onset, but long progression and prolonged course of disease.
(4) marked testicular enlargement either unilaterally or bilaterally with tenderness, variable epididymal enlargement, inconspicuous thickening of the spermatic cord, scrotal skin edema, mostly dark red in color, diffuse swelling.
(5) May be combined with mumps virus, pancreatitis or encephalitis, with increased blood and urine amylase.
3, pediatric testicular torsion: pediatric testicular torsion is relatively rare, but the consequences are serious, the pathological basis for the normal testicular sheath sinus is not closed or closed position is high, so that the testis in the sheath capsule has a relatively free spermatic cords, once the testis occurs relative rotational movement, both testicular torsion can occur, the boy combined with incomplete descent of the testis, manifested as the testicular sheath sinus protrusion is not closed, the testis is located in the middle of the groin, testicular torsion testicular necrosis occurs, testicular necrosis at surgery, orchiectomy, proximal hernia sac ligation, contralateral testicular fixation, and another high atresia of the sphincter sinus, causing torsion of the seminiferous tip, which can be avoided by orchiectomy in time for surgery.
Due to the above pathological basis, the following characteristics of testicular torsion can be identified.
(1) rapid onset of testicular torsion in pediatric patients, severe testicular pain, and a short time between onset and consultation, mostly within one day.
(2) Trauma or causative factors are unclear, but if a child with ipsilateral cryptorchidism is suddenly found to have an obvious painful mass in the groin that cannot be returned, the possibility of undescended testicular torsion should be considered.
(3) Diffuse scrotal swelling is not as obvious as testicular adnexal torsion, but testicular enlargement is obvious with severe pain, and part of it may be radiating pain to the groin or perineum, and at the same time, the texture of the enlarged testicle can be found to be hardened or there are obvious nodule-like masses on the upper pole of the testicle.
(4) Testicular swelling is not prominent, but thickening of the spermatic cord is obvious, accompanied by significant pain.
(5) Elevated testicular position with most positive elevation pain.