Acute Scrotum

Question 1

What is your differential for acute scrotum?

Answer 1

testicular torsion

torsion of the appendix of testicle

epididymitis

orchitis

trauma

incarcerated hernia

Question 2

What is the pathophysiology of testicular torsion

Answer 2

inadequate fixation of testis via gubernaculum within the scrotum

• redundant tunica vaginalis
• bell clapper deformity

venous congestion leads to arterial flow interruption

Question 3

What are the diagnostic features (5) for testicular torsion?

Answer 3

pain

swelling

absent cremasteric reflex

abnormal lie - high riding and side lying

nausea/vomiting

Question 4

What is the investigation needed for testicular torsion?

Answer 4

ultrasound with Dopplers

Question 5

How do you manage a testicular torsion?

Answer 5

Manual detorting - open book method

Urgent surgical detorsion and orchidopexy/orchiectomy

Question 6

What is Prehn’s sign

Answer 6

Elevation of affected scrotum in epididymitis will improve pain, whereas it will not in torsion

Question 7

What are the physical exam findings in torsion of the appendix of the testis

Answer 7

testicle nontender

tender mass that may be palpable

blue dot sign

normal cremasteric reflex

Question 8

What is the management of torsion of appendix of testis

Answer 8

Supportive care

• analgesia
• rest
• scrotal support to allievate swelling
• should resolve in 5-10d

Question 9

What are the common bugs in epididymitis

Answer 9

Sexually active - chlamydia, gonorrhea, e.coli, viruses

Not sexually active - Mycoplasma pneumoniae, enteroviruses or adenoviruses

Question 10

What is the clinical presentation of epididymitis

Answer 10

subacute/acute onest of pain and swelling to epididymis

lower UTI symptoms + fever

red/edematous scrotum but otherwise normal (normal cremasteric reflex)

Question 11

How do you diagnosis epididymitis

Answer 11

urinalysis and culture

STI testing

ultrasound with Dopplers - increased blood flow

Question 12

What is the treatment for epididymitis

Answer 12

Ceftriaxone 250mg IM x 1

Doxycycline 100mg PO BID x 7d

Otherwise supportive care

Question 13

What are the most common etiologies for orchitis

Answer 13

VIRAL

mumps, rubella, coxsachie, echo virus

Question 14

What are the clinical manifestations of orchitis

Answer 14

Scrotal swelling

pain

tenderness

erythema and shininess of skin

Question 15

How do you manage orchitis

Answer 15

Supportive care