A male client presents with sudden severe scrotal pain radiating to the groin, swelling, and nausea. Which condition should be suspected first?

• A. Epididymitis
• B. Hydrocele
• C. Varicocele
• D. Testicular Torsion

Answer: (D)

Sudden, severe scrotal pain with radiating groin discomfort and nausea is classic for testicular torsion, a condition where the spermatic cord twists and cuts off blood flow to the testicle. This is a surgical emergency because every minute counts; the sooner the blood flow is restored, the better the chance of saving the testicle. On exam, torsion often presents with a high-rlying, horizontally lying testis and an absent cremasteric reflex on the affected side, which helps distinguish it from other scrotal problems.

Epididymitis usually evolves more gradually and is often associated with urinary symptoms or fever, and the cremasteric reflex is typically preserved. A hydrocele is a painless scrotal swelling that transilluminates, not an acutely tender, rapidly swelling structure. A varicocele feels like a “bag of worms” and is usually a chronic, nonacute finding rather than an abrupt, painful episode.

In practice, if torsion is suspected, treat as an emergency: urgent urologic intervention for detorsion and fixation, with the goal of saving the testis. If there’s any delay to surgery, an attempt at manual detorsion can be considered to relieve pain and restore blood flow, but definitive treatment is surgical exploration and bilateral orchiopexy to prevent recurrence. Imaging with Doppler ultrasound may be used if it won’t delay treatment, to confirm reduced or absent blood flow.