A variety of scrotal and non-scrotal pathologies 38
may present with acute scrotal pain. Differential 39
diagnosis is important, since management is 40
different. When history and physical examination 41
strongly suggest the presence of testicular torsion 42
and the duration of pain is less than 12 h, urgent 43
surgical exploration is mandatory. When pain is 44
present for more than 12 h or the diagnosis is 45
unclear, color Doppler ultrasound can be helpful in 46
decision making. It is important to remember that 47
most patients with an acute scrotum do not have 48
testicular torsion. In case of epididymo-orchitis, 49
pathogen-directed antibiotic therapy is required. 50
Furthermore, bed rest, scrotal elevation and the use 51
of non-steroidal anti-inflammatory agents are use- 52
ful in reducing the duration of the symptoms.
