Pain and swelling of the scrotum, epididymitis and torsion

Abstract

The differential diagnoses for the acute scrotum are extensive, but torsion of the spermatic cord (commonest in boys aged 13–17 years and the commonest cause of acute scrotal pain and swelling up to 18 years of age) must be excluded. Torsion requires emergency surgical exploration and detorsion if the testis is to be salvaged. The management of perinatal torsion is controversial and best dealt with by dedicated Paediatric Units. Epididymitis is a more common finding in males aged >18 years, and is usually caused by chlamydial, gonococcal or coliform infection. Investigations, antibiotic treatment and follow-up should be based on national guidelines published in 2001. Torsion of the appendix testis and appendix epididymis, remnants of the Müllerian and Wolffian ducts, respectively, can mimic the more common diagnoses, but most cases resolve spontaneously with non-surgical treatment. Torsion of the testis is more likely if the onset of pain is sudden, the pain is severe and the patient is aged <20 years. An emergency scrotal exploration should be undertaken if the diagnosis is in doubt.