Acute Scrotum: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes [Purpura Schoenlein-Henoch (Purpura anaphylactoides) – spontaneous small skin hemorrhages, especially in the area of the lower legs (pathognomonic), which occurs mainly after infections or due to drugs or food; in this case, the epididymis or testis is frequently enlarged]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Palpation (palpation) of the abdomen (belly), inguinal region (groin region), etc. [a thickened swelling in the inguinal canal area may indicate an incarcerated inguinal hernia / incarcerated inguinal hernia].
    • Inspection and palpation of the genitalia (penis and scrotum) [testicular location, size, and painfulness compared to the opposite side or where is the punctum maximum of pain); dark blue to black discoloration of the testis; often the testis is fixed close to the body on the affected side or lies transversely, due to torsion of the shortened spermatic cord/Brunzel’s sign: fixed, painful, horizontal protrusion of the testis in the presence of testicular torsion][due todifferential diagnosis
      • Hydatid torsion: on diaphanoscopy (fluoroscopy of the scrotum with light), so-called “blue dot sign” (bluish shimmering structures; 20% of cases) are frequently found in such cases, as an indication of circulatory disturbance of the appendices of the testis or epididymis; palpable painful nodule
      • Hydrocele (accumulation of serous fluid around the testis) and funiculocele (cyst in the region of the spermatic cord): bulging elastic space with homogeneous transparent fluid bubble; also detectable by diaphanoscopy]
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency.

Square brackets [ ] indicate possible pathological (pathological) physical findings.

The following signs are suitable for differential diagnosis of testicular torsion or orchitis:

  • Cremasteric reflex (testicular elevator reflex; trigger: brushing the inner thigh) – the cremasteric reflex is abolished [may be absent in testicular torsion].
  • Prehn’s sign:
    • Positive: when lifting the testicle, the pain decreases, indicating orchitis or epididymitis.
    • Negative: when lifting the testicle, the pain increases or remains unchanged, which is the case, for example, with testicular torsion
  • Gersche’s sign – retractions of the scrotal skin at the base of the scrotum [indicating an early stage of testicular torsion].