Changes in the appearance of the scrotum and its painfulness may produce a number of acute or chronic diseases which occur in the scrotum, or are located elsewhere in the body, or systemic diseases may be involved. Possible torsion must be considered in every patient who complains of sudden pain and an enlarged testis. Torsion of the testis is an acute surgical attack as the hope of saving the testis declines with advancing time during which the blood flow through the testis is discontinued or significantly reduced. An acute attack is also an incarcerated inguinal or scrotal hernia. A similar condition may be produced by other diseases which as a rule do not call for urgent treatment. This pertains to torsion of the testicular adnexa, orchitis, epidymitis, injury, local infection, hydrocele, variocele and scrotal changes in Henoch-Schönlein’s purpura, lymphoedema, or a condition described as idiopathic oedema of the scrotum. Comprehensive examination must include recording of the case-history, detailed palpation examination of the scrotum and abdomen. Imaging examination (sonography with coloured Doppler, scintigraphy) is made in case of an obscure finding and excessive delay of surgical revision. Surgery is indicated always unless torsion of the testis is unequivocally ruled out.

        Key words: acute scrotal syndrome, acute scrotum, testicular torsion, torsion of the testicular appendix, orchitis, epididymitis, Henoch-Schönlein’s purpura, idiopathic oedema of the scrotum, Fournier’s gangrene, scrotal injury, varicocele, hydrocele, scrotal hernia