The acute paediatric scrotum.

The essentials of management remain the same whatever the cause of the acutely painful scrotum. 1. History is paramount. At what time did the pain come on and with what severity? Has this changed in any way? Is there any aggravation or relief and with what is the pain associated? Are there any urinary symptoms of note? Have there been any previous episodes of pain, possibly of lesser severity? How does the patient feel? 2. Always examine the whole child. Does he look unwell or in pain? Does he have a fever? Is he tachycardic? Is his abdomen soft? 3. Stand the boy up and note the position in which he stands. Look at the scrotum. Does the skin look normal or oedematous? What is its colour? What is the lie of the testis? Remember the left usually sits a little lower than the right. Do the testes hang transversely or at an angle? Is there any swelling of the groin that might indicate a hernia? 4. Elicit the cremasteric reflex on both sides, starting with the unaffected. Examine the normal, unaffected side and determine the anatomy. Ask if you can palpate the affected side. Isolate the testis and grasp it transversely, as anteriorly as possible. Establish whether tenderness is global, superior or posterolateral. If possible, stretch the skin gently over the upper aspect and look for the 'blue dot'. 5. There are no investigations of choice save prompt surgical opinion and exploration. Remember the relative incidences of the various diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)