Acute scrotum

Definition

Acute scrotum is a clinical condition characterized by sudden scrotal pain, swelling, and redness.

The differential diagnosis includes:

• testicular torsion (an emergency);
• epididymitis/orchitis;
• torsion of the appendix testis;
• scrotal trauma;
• strangulated inguinal hernia;
• idiopathic edema.

Clinical assessment

• Onset (usually sudden in torsion, gradual in epididymitis).
• Pain severity.
• Temperature, nausea, vomiting.
• Testicular position (high-riding, horizontal in torsion).
• Cremasteric reflex (absent in torsion).

Diagnosis

• Use color Doppler ultrasonography when the diagnosis is uncertain, provided it is immediately available and does not delay surgical exploration.
• Reduced/absent blood flow → torsion.
• Increased blood flow → epididymitis/orchitis.
• Laboratory tests: CBC, CRP, urinalysis, and culture if infection is suspected.

Emergency management

If testicular torsion is suspected:

• When clinical suspicion is high, perform immediate surgical exploration without waiting for imaging. The 4–6-hour interval is a prognostic window, not a reason to withhold surgery after a late presentation.
• Do not delay for investigations—time is critical.

In epididymitis/orchitis:

• Antibiotics (fluoroquinolones, cephalosporins).
• Rest, cold application, anti-inflammatory medication.

Algorithm