Any child with acute scrotal swelling or pain requires urgent assessment to identify or exclude two surgical emergencies: torsion of the testis and incarcerated inguinal hernia.
Minor scrotal trauma may be reported, but beware of assuming that this is the cause of pain. Obvious severe blunt trauma to the scrotum may result in rupture of the testis or epididymis, and requires urgent surgical referral.
Doppler ultrasound, nuclear scans and blood tests are not reliable in confirming/excluding the diagnosis of testicular torsion and often delays definitive treatment.
Acute Painful Swelling of Scrotum
Clinical distinction between the conditions below are very difficult, and the policy at PMH is not to spend time on investigations, but to refer for surgical opinion to consider immediate scrotal exploration for both diagnosis and treatment.
Urgent referral to general surgeon
Keep child fasted until surgical review
Torsion of Testis
Sudden onset of testicular pain and swelling
Pain may refer to abdomen
In pre-verbal younger boys, vomiting may predominate the presentation