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7.07 Epididymitis


Presentation

An adult male complains of dull to severe scrotal pain developing over a period of hours to a day, and radiating to the ipsilateral lower abdomen or flank. There may be a history of recent urethritis, prostatitis or prostatectomy (allowing ingress to bacteria), straining with lifting a heavy obiect, or sexual activity with a full bladder (allowing reflux of urine). There may be fever, nausea, or urinary urgency or frequency. The epididymis, is tender, swollen, warm, and difficult to separate from the firm, nontender testicle. Increasing inflammation can extend up the spermatic cord and fill the entire scrotum, making examinations more difficult, as well as produce frank prostatitis or cystitis. The rectal exam therefore may reveal a very tender, boggy prostate.

What to do:

What not to do:

Discussion

Testicular torsion is more likely in children and adolescents, and has a more sudden onset, although it can be recurrent and is often related to exertion or direct trauma. If the spermatic cord is twisted, the testicle may be high, the epididymis may be in other than its normal posterior position, and there will most likely be no cremasteric reflex. A testicular scan can help differentiate torsion from the sometimes similar presentation of acute epididymitis. When torsion is highly suspected you may try a therapeutic detorsion by exter nally rotating the testicle 180 degrees with the patient standing

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD