Scrotal pain

Question 1

Probability diagnosis

Answer 1

Trauma including haematoma, haematocele

Torsion of a testicular appendage

Varicocele

Epididymitis

Post vasectomy

Question 2

Serious disorders not to be missed

Answer 2

Vascular:

• testicular torsion

Infection:

• acute epididymo-orchitis/orchitis
• fulminating necrotising cellulitis (Fournier‘s gangrene)
• psoas abscess
• tuberculosis

Cancer:

• testicular neoplasm

Other:

• strangulated inguinoscrotal hernia
• acute hydrocele

Question 3

Pitfalls (often missed)

Answer 3

Referred pain (e.g. spine, ureteric colic, abdominal aorta)

Rarities:

idiopathic scrotal oedema

polyarteritis nodosa

filariasis

Question 4

Key history

Answer 4

Determine any pre-existing predisposing factors such as;

• lumps or
• history of trauma

Check travel history, sexual history.

Question 5

Key examination

Answer 5

Examine and contrast both sides of the scrotum, including;

• the inguinal and femoral hernial orifices
• the spermatic cord
• testis and epididymis

Examine the pt standing and supine

A painful testis should be elevated gently to determine if the pain improves

Question 6

Key investigations

Answer 6

FBE

urine analysis, microscopy and culture

Chlamydia detection tests

ultrasound

technetium-99m scan.

Question 7

Diagnostic tips

Answer 7

Torsion of the testis is the most common cause of acute scrotal pain in infancy and childhood.

Think of it with lower abdominal pain and/or vomiting.

A varicocele can cause testicular discomfort;

• —examine the patient in the standing position.

Question 8

Red flags:

Answer 8

sudden onset pain

non-reductible hernia

erythema of scrotum or perineum

systemic vascular symptoms, e.g. hypotension, pallor.