Epididymitis Case Study

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study may show only increased blood flow to the adjacent epididymis and testis and possibly a reactive hydrocele, resulting in the misdiagnosis of acute epididymitis or epididymoorchitis.
Torsion of the appendage is a self-limited condition that responds best to nonsteroidal anti-inflammatory medications and comfort measures such as limited activity and a warm compress. As the appendage infarcts and necroses, the pain resolves. Such torsion can recur because five appendages potentially may experience torsion
(appendix testis, appendix epididymis, paradidymisorgan of Giraldes, superior and inferior vas aberrans of
Haller). Surgical intervention is indicated when the diagnosis of testicular torsion cannot be eliminated or when the symptoms are …show more content…

4).
Classic bacterial epididymitis generally has a slow onset and is characterized by scrotal pain and swelling that worsens over days rather than hours. Usually, there is no nausea or vomiting. Bacteria are believed to reach the epididymis in retrograde fashion via the ejaculatory ducts and can be associated with a urinary tract infection or urethritis. A positive result from urinalysis and culture, or urethral swab in sexually active adolescents, suggests the diagnosis. Chlamydia and gonococci are described as the classic causative agents in the sexually active individual; common urinary pathogens, however, including coliforms and Mycoplasma sp, are more probable in younger children. When studies suggest a bacterial infection, antibiotics are indicated. Just as for any urinary tract infection in a boy, radiographic imaging, including renal and bladder ultrasonography and voiding cystourethrography, should be obtained after the infection has resolved.
Anatomic abnormalities such as ectopic ureter to the vas, ejaculatory duct, or seminal vesical; ejaculatory duct obstruction; or urethral valves are uncommon but should
be …show more content…

Treatment of affected children via a timed voiding regimen, dietary modification, aggressive management of constipation, and sometimes anticholinergic or alpha-antagonist medication is effective. Henoch-Scho¨nlein purpura is a vasculitic syndrome that can affect the skin, joints, gastrointestinal tract, and genitourinary system. Pain, erythema, and swelling of the scrotum and spermatic cord occur in up to one third of patients. The swelling seems to occur more commonly in boys younger than 7 years of age. Scrotal findings and onset of pain may mimic testicular torsion, but Doppler ultrasonography reveals good blood flow to the testes.
The history may document other systemic symptoms such as purpura of the skin, joint pain, and hematuria.
Figure 4. Intraoperative example of torsed appendage of testicle (white arrow) with two other nontorsed appendages held in forceps. genital system acute testicular disorders
Pediatrics in Review Vol.29 No.7 July 2008 239
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