Acute Scrotum

Acute scrotum is defined as an acutely painful, swollen scrotum or its contents. It makes up <1% of ED presentations (Davis, 2011). Not only can the acute scrotum pose a threat to the patient’s future fertility, but it can also have significant psychological implications, making it a highly sensitive and anxiety-provoking presentation for both the patient and clinician.

The three most common causes of acute scrotal pain include testicular torsion, torsion of testicular appendage and epididymo-orchitis. It is imperative that any life or fertility-threatening condition is considered and ruled out. These include testicular torsion, incarcerated hernia and fournier’s gangrene. 

Assessment

Any acute scrotum should be Triaged Category 2.

A suspected testicular torsion should have an IMMEDIATE SURGICAL REVIEW for consideration of urgent diagnostic and therapeutic exploration in theatre. 

History

• Pain – location, time of onset, intensity, radiation
• Associated symptoms – Nausea, vomiting, urinary symptoms, fevers
• History of trauma
• Sexual History
• PMH/Co-morbidities – Diabetes, Immunosuppression.

Examination

• Observations = HR, BP, Temperature
• Abdomen
• Genitalia
• Lymphadenopathy

Clinical findings and potential pathology to consider:

• Testicular Torsion

   

• Epididymo-orchitis

   

• Fournier's Gangrene

   

• Further References and Resources