Scrotal Disorder
Acute painful scrotum
⚫ Causes
1- Torsion of spermatic cord
2- Torsion of appendix of testis
3- Torsion of appendix of epididymis
4- Acute epididymitis
5- Acute epididymo-orchitis
6- Strangulated indirect hernia
7- Bleeding or infarction in testicular tumor
8- Traumatic haematocele
9- Acute idiopathic scrotal oedema
10- Inflammatory lesion in scrotal skin as infected sebaceous cyst or Fournier’s
gangrene
11- Henoch- Schoenlein purpura (scrotal vasculitis)
Differential diagnosis between torsion and epididymitis
Torsion Epididymitis
Age Children or adolescent Rare in children,
common in middle age
or old age
Pain Severe pain followed by swelling Usually swelling
followed by pain
Fever Absent Present
Lower urinary Absent Present
symptoms
Torsion Epididymitis
Testis Higher up Normal
Axis of the Transverse Normal
testis
Epididymis Anterior Normal
Cremasteric Inactive Normal
reflex
Elevation of Pain increase Pain relieved
testis up
(prehan’s
sign)
Doppler Absence of arterial flow Increase in arterial flow
ultrasound
Decrease blood flow Increase blood flow
Radio-isotope
scanning
Torsion Epididymitis
Treatment Trial to do manual Strong analgesic -I.V
detorsion if failed antibiotic for 10 days
urgent exploration followed by oral
must be done within 10 antibiotic for 4 weeks
hours and orchiepexy if Anti- inflammatory
the testis is viable ,
orchectomy if not Testicular elevation
viable with fixation of
contralateral testis
Torsion of spermatic cord
➢ Caused by lack of normal fixation of an appropriate portion of the testis and
epididymis to the fascial and muscular covering ( bell- clapper deformity)
➢ Usually testis rotate invard along its anterior axis
Torsion of Testicular Appendages
⚫ Appendix of testis is a remnant of mullerian duct, appendix of epididymis is a
remnant of wolffian duct
⚫ Presented by localized pain and swelling at the upper pole of the testis or
epididymis respectively
⚫ In some case infracted appendages are seen as blue dot sign
⚫ Treatment conservative no surgical interference except if doubtful
