ABSTRACT
The most important cause to exclude is torsion of the testis, as this is a surgical emergency. Other differential diagnoses include the following: scrotal trauma, epididymo-orchitis, torsion of the testicular or epididymal appendage, incarcerated hernia, and idiopathic scrotal oedema. The definitive management involves performing a scrotal exploration. The patient's informed consent is obtained to perform an orchidectomy. The patient should be anaesthetised and placed in a supine position. Make a longitudinal incision through the raphe of the scrotum. Release the torted testis by untwisting it and then assessing the viability. It should then be wrapped in gauze soaked in warm saline for 10 minutes. In the mean time the contralateral side is fixed to prevent further torsion. Therefore the contralateral hemiscrotum should be explored, and the testis should be fixed by invaginating the tunica vaginalis and applying three-point fixation of the scrotum with non-absorbable sutures to the scrotal wall. The incision is closed with absorbable sutures.
