Tumour, Torsion or Trauma?

Abstract

The acute scrotum is a common surgical emergency. Laboratory and radiological investigations are key adjuncts to diagnosis but may occasionally mislead. The condition remains a diagnostic challenge for clinicians and fertile ground for litigation. We present a case of a 22 year old who was managed by various levels of clinicians for a 12 day period prior to testicular exploration which finally revealed testicular torsion. Remarkably, the testis was viable and the finding of a hematoma of the epididymis suggested a history of trauma which was not forthcoming from the patient.The acute scrotum demands expeditious attention and the clinician must aim to reach a definitive diagnosis in the shortest time possible through thorough history taking and physical examination. Scrotal ultrasound with Doppler examination is a useful adjunct, but investigations must not delay emergent scrotal exploration when testicular torsion is suspected clinically. Relevant consultations and referrals must also be urgent where the results of treatment are suboptimal or the evolution of symptoms leads to diagnostic uncertainty.