Introduction: Acute Scrotum is an emergency with vast number of differential diagnoses with potential to have short and long term complications. Low salvage rates are often secondary to misdiagnosis and delayed presentation. Late presentation remains the greatest cause of orchiectomy.Many studies had been conducted, on whether every patient of acute scrotum should be explored or not on solely clinical grounds. Objective: The purpose of this study was to study the etiology, age incidence, the differential diagnosis and complications in patients with acute scrotum. Methods: The present prospective observational study was carried out at a tertiary care centre from August 2015 to November 2017 amongst 102 patients diagnosed and admitted for acute scrotum.   Results: Out of 102 patients acute scrotum majority 74 (72.54%) had epididymitis and/or orchitis, 6 (5.88%) testicular torsion, 20(18.6%) pyocoele. In final diagnosis, we got 20 patients of pyocoele but only 17 patients were diagnosed clinically, while 3 patients were earlier diagnosed as epididymo-orchitis. Out of 6 patients of testicular torsion, in 3 patients we were able to save testis and bilateral orchiopexy was done. Out of 20 patients of pyocoele, 3 patients were complication of epididymo-orchitis and 2 of testicular torsion. In 8 patients with gangrenous testis orchiectomy was performed. Conclusion: Overlap exists between testicular torsion and other conditions of acute scrotum in the younger population. The clinical manifestations, physical examination findings, and laboratory test results are helpful in distinguishing the etiology; however, ultrasonography and color Doppler help in the diagnosis and immediate treatment for testicular torsion.