Chapter 3 ACUTE SCROTUM
General Discussion
Every male patient with the acute onset of pain and swelling of the scrotum requires an immediate evaluation to diagnose or exclude testicular torsion. Of the cases of acute painful scrotum, 30% are caused by testicular torsion. Testicular torsion represents a true surgical emergency because the likelihood of testicular salvage decreases as the duration of torsion increases. The rate of testicular salvage is highest with symptoms 6 or fewer hours in duration. In children in whom the duration of symptoms is short and in whom clinical history and physical examination strongly suggest the diagnosis of acute testicular torsion, imaging studies may be bypassed in favor of surgical exploration.
The age of the child may help guide the evaluation. Testicular torsion may occur at any age but is more common during the newborn period and during early puberty. Appendiceal torsion and Henoch-Schönlein purpura are more common in prepubertal boys. Epididymitis is more common in adolescents and young adults.
The abrupt onset of severe pain is characteristic of testicular torsion. Mild to moderate pain that develops over several days is more suggestive of epididymitis or appendiceal torsion. An acute scrotal process may be referred to the abdomen, so any child presenting with an acute abdomen must have a complete genital examination.
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