Journal of Surgery and Surgical Research ISSN: 2455-2968 CC By 019 Citation: Shah A (2018) Scrotal emergencies-Two case reports on scrotal exploration scenarios. J Surg Surgical Res 4(2): 019-022. DOI: http://doi.org/10.17352/2455-2968.000054 Clinical Group DOI: http://dx.doi.org/10.17352/jssr Abstract This case report evaluates the management of acute scrotal emergency in two similar cases with presenting complaints and different outcomes post-scrotal exploration. One case of young male discusses the eventual outcome of testicular torsion and importance of urgent exploration combined with careful cord examination, whilst second case was simply a hematocele requiring excision of sac. There is overall discussion of importance of scrotal exploration, even if at times it may not yield any positive findings. Case Report Scrotal emergencies-Two case reports on scrotal exploration scenarios Abhijit Shah* IInd year resident department. General surgery Author University. Sir JJ Group of Hospitals, Mumbai, India Received: 17 September, 2018 Accepted: 03 October, 2018 Published: 04 October, 2018 *Corresponding author: Dr. Abhijit Sanjay Shah, A/604, shivkripa, Model Town, Andheri west, Mumbai 400053, Maharashtra, India, Tel- 9967059506/9137474445; E-mail: Keywords: Scrotal emergency; Testicular torsion; Hematocele; Scrotal exploration https://www.peertechz.com Introduction An acute scrotum is defined as an acute painful swelling of the scrotum or its contents, accompanied by local signs or general symptoms. Early identification and skillful management of testicular torsion is critical, as it may threaten testicular viability and future fertility if not managed expediently and appropriately. The cremasteric reflex and testicular sonography are frequently used, yet imperfect, diagnostic tools in assessing for testicular torsion. Other emergent conditions include incarcerated inguinal hernia, Fournier's gangrene, and any form of genitourinary trauma until proven otherwise [1]. Hence the option of scrotal exploration. The aim of these case descriptions is to emphasize the urgency of scrotal exploration and mistakes that occur during the same, and not to be deterred by negative exploration during the same. Case Scenarios Case 1 A 19 year old male, presented to GT Hospital Emergency Dept, with acute onset scrotal pain, fever and multiple episodes of vomiting. Patient complains of mild pain 24 hours before the episode during night time whilst the patient was sleeping and with no apparent h/o trauma. Patient was immediately admitted. On admission patient was tachycardiac (102/min), normotensive (124/70mmHg) and appeared in distress with no evidence of palor or signs of dehydration. Clinical Examination further revealed no abdominal tenderness, palpable organomegaly or signs of trauma/ previous surgeries. Local Scrotal examination revealed tenderness in the Right Hemiscrotal region with no relief experienced on lifting the testis to relax the cord on the affected side, with no obvious signs of tenderness on the contralateral side. (Figure 1) Chest Xray, Abdominal Xray depicted no significant abnormality. On an emergency ultrasound revealed Right sided Torsion testis with reduced vascularity and emergency urological consult advised emergency Orchidectomy with contralateral Orchidopexy. Patient was shifted to the Emergency OT within the hour. After due consents and pre-operative preparations, patient was induced under Spinal Anesthesia with careful monitoring. Scrotal exploration, however, revealed healthy viable testis with certain amount of cord edema at the head of epididymis without evidence of any blackening over the testes and without evidence of torsion along the length of cord or the testis itself. Figure 1: ICredit: Dr. Abhijit Shah, Gokuldas Tejpal Hospital, Surgery OPD, Mumbai.