Acute SCROTUM. Testicular torsion Appendage torsion Epidydimitis Orchitis Trauma Tumor ? Hernia ?. Testicular Anatomy. The normal testis is oriented in the vertical axis and the epididymis is above the superior pole in the posterolateral position.
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Most torsions due to bilateral anatomic abnormality. Tunica vaginalis has a high insertion about the spermatic cord.
Resultant bell-clapper deformity—testis dangles in the scrotum and is mobile
In men > 40, E. coli is the predominant pathogen. Other coliform organisms, Pseudomonas, and gram positive cocci. Associated w/ underlying urologic pathology -- Recent GU tract manipulation or bacterial prostatitis.
In men <40, Chlamydia and N. gonorrhoeae are the major pathogens