Acute scrotum

Objectives

To provide guidance for (a) the diagnosis of testicular torsion (b) surgical steps for testicular exploration surgery.

Scope

These guidelines are for deployed clinicians who diagnose or treat suspected testicular torsion.

1. Differential diagnoses for testicular pain

2. Guidance for diagnosing testicular torsion including use of imaging and scoring systems.

3. Surgical steps for scrotal exploration.

Audience

This guideline is intended for the use of registered healthcare professionals fulfilling a general role in a forward medical location or in an Emergency Department on deployed operations. 

Initial Assessment & Management

Advanced Assessment & Management

Prolonged Casualty Care

Decision making for torsion should be made as early as possible and prolonged casualty care should not affect initial decision making. 

With significant delay to presentation (>24 hours) and a non-viable testicle, orchidectomy will be required to reduce infection and anti-sperm antibodies. In theatre versus evacuation to Role 4 will depend on operational tempo. 

Any doubt about viability of the testicle warrants exploration.

Paediatric Considerations

Torsion is a frequent diagnosis in children. Paediatrics is outside the scope of this CGO and differential diagnoses are not included, but if torsion is suspected surgery should be performed in all age groups, in discussion with anaesthetics and nursing support.