Author: Devarsh Joshi / Editor: Jessie Lynch / Codes: / Published: 20/08/2025
A 13-year-old boy presents to the Emergency Department (ED) with sudden onset of severe left-sided scrotal pain that began around 3 hours ago while watching TV. He describes the pain as constant, sharp and worsening, and says he feels nauseous but hasnt vomited. He doesnt report any trauma, fever or urinary symptoms.
His mother reports he was completely well earlier in the day and has no relevant past medical history.
On examination, the patient appears distressed and is lying on his side with his knees drawn up. He resists abdominal palpation but has no guarding or rebound tenderness. Inspection of the scrotum reveals swelling and erythema on the left side. The left testicle is markedly tender and swollen, making it too painful to accurately assess position or lie. The cremasteric reflex is absent on the left. The right testicle is non-tender and in a normal position.
Vital signs are normal. Urinalysis is negative for leukocytes, nitrites, or blood.
