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 testicular appendage or torsion of the testis. It may be difficult to distinguish the two conditions clinically with certainty. Where torsion of the testis has occurred, delay in diagnosis and treatment increases the likelihood that the testis will be found dead at the time of surgical exploration. This review identifies the main causes of diagnostic error and describes how the various traps in clinical assessment can be avoided.