Do all children with an acute scrotum require exploration?

A total of 77 consecutive children ranging in age from 1 day to 17 years was evaluated for an acute scrotum by a single examiner (E. J. K.). In 10 children a definite diagnosis of acute spermatic cord torsion was made based upon the history and physical examination. No imaging studies were performed and torsion was confirmed at surgery in 9 children. The diagnosis of testis torsion was not as clear-cut in the remaining 67 children and, therefore, a color Doppler ultrasound was performed before any surgical intervention. The study demonstrated normal or increased blood flow in 55 of these children and none proved to have testicular torsion, although other scrotal pathology requiring surgery was noted in 5 children. Twelve children did not demonstrate evidence of testicular blood flow on the color Doppler ultrasound and all had surgical confirmation of testis torsion. We conclude that in our experience the majority (71%) of children with an acute scrotum did not require immediate surgical exploration. Color Doppler ultrasound can reliably identify those children with an acute scrotum who require exploration and spare the majority needless surgery. Routine scrotal exploration is no longer necessary for all children with an acute scrotum.