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.
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