Scrotal Emergency (Acute Scrotum)

Torsion of testicle

  • Occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum
  • Typically in teenage boys, but can occur at any age
  • Bell clapper deformity is a predisposing factor - insertion of the tunica vaginalis is high, meaning testis can rotate and even sit laterally
notion image

Clinical presentation

  • Sudden, severe, testicular pain (in the groin and lower abdomen) and tenderness
  • There is often associated nausea and vomiting
  • The testis may be higher than its normal position
  • Mild pyrexia and redness of overlying area may be found
  • The cremasteric reflex is often reduced or absent

Management

  • Surgery

Epididymoorchitis

  • Inflammation of the testis and epididymis secondary to infection
  • In <35s, the most common causes are STIs (e.g. N. Gonorrhoea)
  • In those over 35 years old, E. coli - originating from the GI tract - is the most common cause

Clinical presentation

  • Acute onset, severe testicular pain
  • Patient may feel unwell and have a history of dysuria and urethral discharge (due to an STI)
  • On examination, the testis is warm, red, hot and swollen and is tender to touch
  • The classic finding on testicular examination that supports epidydmo-orchitis is the alleviation of pain upon elevation of the testes

Management

  • Analgesia and antibiotics