Pediatric Scrotal Pain

Acute scrotal pain in pediatric patients requires rapid clinical assessment to distinguish time-sensitive emergencies like testicular torsion from benign conditions. Torsion accounts for 10–15% of presentations and demands immediate surgical intervention within a four-to-six-hour window to ensure testicular salvage. Utilizing the TWIST score—which evaluates testicular swelling, hardness, position, cremasteric reflex, and associated nausea—enables effective risk stratification and helps determine the necessity of ultrasound versus direct transfer to the operating room. While epididymitis remains a common differential, it is frequently viral in etiology, necessitating urinalysis and culture rather than empiric antibiotics. Clinicians should maintain a high index of suspicion for extra-testicular causes, including appendicitis and nephrolithiasis, while considering manual detorsion as a temporary measure to preserve tissue viability during delays in surgical access.