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 Testes | Scrotal Swelling | Scrotal skin changes | history of trauma |
---|---|---|---|
Testicular torsion | Hydrocele | Cellulitis | Haematoma |
Torted appendage | Spermatocele | Fournier's Gangrene | Testicular torsion |
Epididymitis | Varicocele | Candida | Testicular rupture |
Orchitis | Idiopathic Oedema | Henoch Scholein Purpura | Epididymitis |
Ruptured epididymal cyst | Nephrotic Syndrome | Ecchymosis/Trauma | |
Tumour | CCF | Insect bite | |
Hernia |