Acute scrotum is a well-recognized clinical condition and a common cause of presentation to pediatric emergency departments. The condition manifests across a wide spectrum of pediatric ages, ranging from neonates to adolescents, with a heightened prevalence observed among postpubertal males [4, 5]. The findings of our study are consistent with the extant literature, as the majority of cases in our cohort were observed in older children.

The most frequent presenting complaints in acute scrotum cases include pain, swelling, erythema, fever, and nausea [6]. In a study evaluation of 133 children with acute scrotum, pain was identified as the most common symptom, followed by erythema [7]. In our study, swelling was the most frequently reported symptom, followed closely by pain. These results demonstrate variability in symptom presentation across different pediatric populations.

When the sample was stratified by age, certain etiologies demonstrated distinct distributions. Epididymitis was most frequently observed in patients older than 8 years (60.4%, 26/43), whereas torsion of the appendix testis was more common in the 2- to 8-year age group (51.5%, 17/33). Furthermore, testicular torsion cases were more prevalent among older children as well, with over half of the cases (57.1%, 16/28) occurring in the > 8 years group. A notable observation was the predominance of other etiologies among children under 2 years of age, constituting 65.6% (21/32) of the cases. These findings are consistent with developmental and anatomical differences that influence pathology in different pediatric age groups.

Concerning the etiology, earlier investigations have indicated that torsion of the appendix testis is the most prevalent cause of acute scrotum in children [8]. However, the study by İpek et al. revealed that testicular torsion and orchitis were identified as the most common diagnoses [9]. In the present study, epididymitis was the most frequently observed pathology, consistent with the extant literature suggesting that epididymitis is the leading cause of acute scrotum [10]. The high incidence of epididymitis in the present cohort may be attributed to a history of previous urinary tract infections in many patients. These findings underscore the importance of a detailed clinical assessment, including kidney and bladder ultrasonography, to rule out potential underlying causes [7].

Testicular torsion is among the most pressing and critical etiologies of acute scrotum. A delayed diagnosis of testicular torsion can result in testicular loss and even legal ramifications [11]. As indicated by the extant literature, the probability of testicular atrophy or loss escalates markedly within the first 24 h following the onset of discomfort [12]. A 20-year retrospective study revealed that the median time from emergency department admission to surgical consultation was 135 min. Shorter times were observed in cases where the testis was salvaged. It is noteworthy that each 10-min delay was associated with a 4.8% reduction in testicular viability, underscoring the necessity for expeditious diagnosis and intervention [13]. In the present study, the temporal parameters associated with emergency department presentation, imaging, and pediatric surgical consultation were thoroughly examined. The findings revealed that testicular torsion cases exhibited significantly prolonged presentation times compared to other etiologies of acute scrotum. Although it is known that testicular torsion usually causes severe pain and requires rapid presentation, the longer presentation time in this patient group in our study suggests that complex factors are involved that cannot be explained by symptom severity alone. This finding points to the presence of parents, especially those living in rural areas, who have low health literacy or are unable to assess symptoms correctly. Therefore, raising public awareness about conditions that require urgent intervention, such as testicular torsion, is of vital importance both to prevent patient loss and to accelerate diagnosis and treatment processes. Given the critical importance of early recognition in testicular torsion, public awareness campaigns and training for healthcare professionals are essential for minimizing such delays [14].

In the present study, the duration of surgical consultations was found to be comparable for patients afflicted with appendix testis torsion and epididymitis. However, cases of testicular torsion exhibited significantly shorter consultation times, reflecting the prioritization and urgency accorded to this condition. The extant literature demonstrates that prompt intervention in testicular torsion significantly improves testicular salvage rates, and that the time from diagnosis to surgical intervention directly affects testicular viability [13]. These findings underscore the critical importance of timely diagnosis and intervention in all cases of acute scrotum.

The absence of a standardized pediatric emergency treatment protocol for acute scrotum and the limited number of cases represent the primary limitations of our study. However, the findings emphasize the critical importance of early diagnosis and treatment in preventing testicular loss. It is imperative to undertake a prompt evaluation and implement suitable interventions for patients exhibiting symptoms suggestive of a specific condition.