Acute testicular disorders.

Introduction Acute scrotal pain with or without swelling and erythema in the child or adolescent male should be treated as an emergent condition. The differential diagnosis includes: torsion of the spermatic cord, appendix testis or epididymis, epididymitis/orchitis, hernia, hydrocele, trauma, sexual abuse, tumor, idiopathic scrotal edema (dermatitis/insect bite), cellulitis, and vasculitis (Henoch–Schönlein purpura). Most of the conditions are nonemergent, but the prompt diagnosis and treatment of torsion of the spermatic cord is imperative to avoid permanent ischemic damage to the testicle. The most common causes of acute scrotal pain are testicular (spermatic cord) torsion and torsion of the rudimentary vestigial appendages of the testicle or epididymis. The child’s age suggests the cause of the acutely painful scrotum because torsion of the appendix testes/epididymis is more common in prepubertal boys and spermatic cord torsion occurs more frequently in adolescents and newborns.