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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:

painful TestesScrotal SwellingScrotal skin changeshistory of trauma
Testicular torsionHydroceleCellulitisHaematoma
Torted appendageSpermatoceleFournier's GangreneTesticular torsion
EpididymitisVaricoceleCandidaTesticular rupture
OrchitisIdiopathic OedemaHenoch Scholein PurpuraEpididymitis
Ruptured epididymal cystNephrotic SyndromeEcchymosis/Trauma 
TumourCCFInsect bite 
 Hernia  

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