ACUTE SWELLING AND PAIN IN SCROTAL REGIONThis is one condition that requires a quick decision and urgent surgery. The usual story is that of a boy who comes home from school or from playing with a pain in the
scrotal region. The onset may have been while the boy was playing or even more often while sitting. There may be some history of trauma, which may lead to the parents to assume that pain is due to direct trauma only. However, the boy must be thoroughly questioned to find out when did the pain actually start, has it remained the same, increased, or decreased and disappeared. Check if the boy is having any urinary problem like burning or painful micturition prior to the pain. Also, one must check for swelling and redness on one side of the scrotum. Thus a boy presenting with pain and swelling on one side of the scrotum has to be given immediate therapy since there are 2 possibilities. The first is Testicular torsion that requires urgent surgery to untwist the torsion; the other is epididymo orchitis that requires purely
non surgical therapy.
The cause is a congenital anomaly wherein, the testis after descending into the scrotum is not fixed in place and is mobile. The testis is free to rotate along its long axis - this in turn leads to a twisting of the blood vessels of the testis and cutting off of the blood supply to the testis. As this progresses, the total blood supply of the testis is cut off leading to gangrene or infarction of the testis. This makes the testis atrophy and loose all functions. The twists can be of various degrees i.e. 180 degrees, 360 degrees - thus it may be one full turn or 2 or more turns. Obviously, more the twists the faster the loss of blood supply. Additionally, the time interval from the occurrence of the torsion and its relief is also very important. If corrected within 6 hours - still about 10% of testis can loose their functions; this can increase to 90 % if the time interval goes more than 24 hours. This then is the reason for urgent intervention and untwisting of the torsion. This is also the reason for showing the proper doctor as soon as possible.
Epididymo orchitis (EO)This is an infective inflammatory condition secondary to
urinary infection. Retrograde infection from the urethra via the vas deferens to the epididymis and testis. The infection and subsequent inflammation lead to pain and swelling in the testicular region very similar to that in torsion. The infection could also have come to the epididymis from the normal blood flow. Rarely there may be an abnormal upper urinary tract anomaly and presents as epididymo orchitis.