Abstract
Background: An acute scrotum is defined as acute pain with or without scrotal swelling, may be accompanied by local signs or general symptoms. Acute scrotal pain is a medical emergency. Depending on cause, the management is entirely different. Torsion of testis and strangulated hernia are surgical emergency; whereas, epididymo-orchitis is treated by medicines. Testicular trauma and obstructed hernia can be differentiated by taking history from patient. Clinical /Physical examination adds only a little information. Color Doppler ultrasound is the modality of choice to differentiate testicular torsion from inflammatory conditions.
 Aim of Study: The aim of this study is to observe the epidemiology of acute scrotum and their presentation, there by facilitating a systematic approach in identifying those patients who need early intervention to decrease associated morbidity and mortality.
 Conclusion: Acute scrotum is a common case seen in the today's scenario with considerable mortality and morbidity. In our study acute epididymo-orchitis was the commonest cause followed by torsion of testis the primary objective of management of acute scrotum is to avoid testicular loss. Acute scrotal swellings are common in younger & middle age individuals with variable symptoms. These cases need careful examination, proper evaluation and prompt treatment. The likelihood of testicular salvage in torsion depends on the interval between onset of pain and surgical intervention. Routine clinical examination gives only a little information. Doppler ultrasound assessment of patients at intermediate clinical risk of testicular torsion significantly reduced the frequency of negative surgical explorations without increased rate of missed testicular torsions.(1) In the imaging algorithm for testicular torsion in childhood, we differentiate between the two main entities, the peri- and neonatal torsion and torsions in children and infants older than 1 month. Imaging should not cause any delay in diagnosis but contribute to increase the specificity of diagnosis of testicular torsion in order to avoid unnecessary surgical explorations. (2)
 Keywords: Sonographic Imaging in Acute Scrotal Pain.
Highlights
The ability to confidently establish a surgical versus a nonsurgical diagnosis for acute scrotal pain is important
Torsion of testis and strangulated hernia are surgical emergency; whereas, epididymo-orchitis is treated by medicines
In our study acute epididymo-orchitis was the commonest cause followed by torsion of testis the primary objective of management of acute scrotum is to avoid testicular loss
Summary
The ability to confidently establish a surgical versus a nonsurgical diagnosis for acute scrotal pain is important. The article emphasizes the importance and protocol of screening of patient with acute scrotal pain to create awareness among primary healthcare providers so as to detect testicular torsion at the earliest, so immediate surgery can be performed to salvage the testis as well as to rule out testicular torsion so that unnecessary surgery can be avoided. A study comparing primary scrotal exploration and initial ultrasound (US) examination with exploration for positive US results or a high clinical suspicion of torsion, showed that US obviated the need for exploration in many patients and shortened hospital stays [4]. This clinical syndrome most often presents with acute onset of pain and swelling. Deferens with extensive involvement (5).Intermittent” testicular torsion is a condition in which patient presents with classical history of torsion but clinical examination and USG scrotum are normal (6) Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, Most are extravaginal, and intravaginal torsion is rare.(7)
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