Diagnosis and Management of Testicular Torsion, Torsion of the Appendix Testis, and Epididymitis

Because acute scrotal pain, swelling, and/or inflammation are a potential surgical emergency, prompt and accurate diagnosis is crucial. The 3 most common etiologies of acute scrotal pain in the pediatric age group are epididymitis, torsion of the appendix testis, and testicular torsion. There are numerous other causes of scrotal pain, which include hernia, hydrocele, trauma, Henoch-Schonlein purpura, idiopathic scrotal edema, and neoplasm, but only testicular torsion requires emergent surgery. History and physical examination, along with adjunctive imaging, can provide important keys to the diagnosis. This article reviews the differential diagnosis and management of the acute scrotal pain in the pediatric population, specifically focusing on testicular torsion, epididymitis, and torsion of the appendix testis.