Background and Objectives: Acute scrotal swelling is a group of heterogeneous disease of the scrotal organs, that have a similar clinical picture and which may require surgical treatment.

Aim: To study the clinical presentation, differential diagnosis, and management of different acute scrotal condition.

Material And Methods: A prospective study was conducted 100 patients among aged between 13-70 years, presenting with acute scrotal swelling. After obtaining ethical committee approval, the study was conducted among the patient who presented with acute scrotal swelling with informed written consent from the patient.

Results: Epididymo-orchitis was found in 48 out of 100 patients and torsion of testis (17), Epididymo-orchitis was found to be common clinical condition followed by torsion of testis which occurs in younger individual. Scrotal swelling associated with pain was the most common presenting feature, where fever and urinary symptoms being most common feature in epididymo-orchitis. Haemogram, urine analysis were not conclusive but supportive to clinical diagnosis. Ultrasound of scrotum was 92.58% sensitive and 100% specific.

The period of hospitalisation was found to be more in fournier's  grangrene (mean 25 days.) rather than epididymo-orchitis 

Conclusion: In our study shows acute epididymo-orchitis found to be commonest condition followed by torsion of testis. Testicular torsion is a true surgical emergency which required careful examination, proper evalution and prompt treatment with early surgical management.                                       

Keywords: Acute scrotum, torsion of testis, epididymo-orchitis, fourniers gangrene.

1. Acute disease of the scrotum(acute scrotal syndrome) author; lorenzo E. derchi, michele bertolotto, massimo valentino 21.12.2017
2. Department of planned surgery and urology-andrology morozovskaya childrens city clinical hospital of moscow
3. William C S.Acute scrotal pathology. Surg C l N America 1982; 62 (6) : 955- 970
4. Williamson R C N. Torsion of the Testis and Allied Condition. Br J Surg 1976; 4. 63: 465-476
5. Julia Spencer Barthold, MD. Campbell’s Urology. 10th edition.Philadelphia: Saunders; 2012 p.3587-3594
6. Baglaj M, Carachi R. Neonatal bilateral testicular torsion: a plea for emer- gency exploration. J Urol 2007;177(6):2296-9
7. Watkin, N.A., Reiger, N.A., and Moisey, C.U. (1996) Is the conservative man- agement of the acute scrotum justified on clinical grounds? Br. J. Urol. 78, 623–627
8. Tracy CR, Steers WD, Costabile R. Diagnosis and management of epididymi- tis. UrolClin North Am 2008;35:101–8
9. Klin, L. Zlotkevich, T. Horne, Y. Efrati, F.  Serour and G. Lotan, “Epididymi-  tis in Childhood: A Clinical Retro- spective Study Over 5 Years,” The Israel Medical Asso- ciation Journal, Vol. 3, No. 11, 2001, pp. 833-855
10. Ben Chaim, I. Leibovitch, J. Ramon, D. Winberg and B. Goldwasser, “Etiol- ogy of Acute Scrotum at Surgical Ex- ploration in Children, Adolescents and Adults,” European Urology, Vol. 21, No. 1, 1992, pp. 45-47
11. Viswaroop BS, Kekre N, Goplalkrishnan G. Isolated tuberculous epididymi- tis:a review of 40 cases. J Postgrad Med 2005;51(2):109-111
12. Yan-Dong Li, Wei-Fang Zhu, Jian-Jun Qiao, Jian-Jiang Lin. Enterostomy can decrease the mortality of patients with Fournier gangrene. World J Gastro- enterol 2014 June 28; 20(24): 7950-7954
13. Bisno AL, Stevens DL. “Streptococcal infections of skin and soft  tissue” North En gland Journal of Medicine 1996, 334: 240-5
14. Patriquin HB, YazbeckS, Trinh B et al. Testicular torsion in infants and chil- dren: diagnosis with Doppler sonography. Radiology 1993; 188(3): 781 - 5
15. Abul F, Al-Sayer H, Arun N: The acute scrotum: a review of 40 cases. Med Princ Pract 2005; 14: 177–81
16. Lloyd J Peterson, Whitlock N W, Odom R B, Ramirez R E, Stutzman R E,M- caninch J W. Bilateral Fat Necrosis of the scrotum. J Urol 1976 ;116 : 825- 826.
17. Teoman Eskitaşcıoğlu, , İrfan Özyazgan., Atilla Coruh et al. Experience  of 80 cases with Fournier’s gangrene and “trauma” as a trigger factor in the etiopathogenesis. Turkish journal of trauma & emergency surgery: TJTES(Im- pact Factor: 0.34). 07/2014; 20(4): 265-274. DOI: 10.5505/tjtes.2014.67670
18. Ruiz-Tovar J, Córdoba L, Devesa JM. Prognostic factors in Fournier gangrene. Asian J Surg. 2012 Jan; 35(1): 37-41
19. Ricordo G. Del Villar, Ireland G W, Cass A S. Early Exploration in acute testic- ular conditions. J Urol 1972; 108 : 887-888
20. Arshad Mehmood Malik, Shiraz Sheikh, Asad Khan, Ubedullah Sheikh. The spectrum of presentation and management of Fournier’s gangrene an expe- rience of 73 cases. org.pk/full_article_text.php?article_id=  2216.  Au-

Dr G. Balasubramanian

Junior Resident, Department of General Surgery, Rajah Muthiah Medical College & Hospital, Annamalai University, Tamil Nadu, India