The acutely painful scrotum in children: how to avoid the traps in diagnosis

The acutely painful scrotum is one of the more common surgical emergencies in the prepubertal boy. It is almost always caused by torsion of a testicul ar appendage or torsion of the testis. It may be difficult to distinguish t he two conditions clinically with certainty. Where torsion of the testis ha s occurred, delay in diagnosis and treatment increases the likelihood that the testis will be found dead at the time of surgical exploration. This rev iew identifies the main causes of diagnostic error and describes how the va rious traps in clinical assessment can be avoided.