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associated with trauma is followed by a pain-free period after which pain returns.
On examination, scrotal erythema, edema, and tenderness of the epididymis may
be found. In this noninfectious variety of epididymitis, the urinalysis is negative.
Sonography is helpful to rule out any more severe injury and will demonstrate
hyperemia associated with the inflammation. Treatment is supportive.

Incarcerated Inguinal Hernia
Incarcerated inguinal hernias are herniations of bowel and omentum into the
scrotum which present with pain and a scrotal mass. Their diagnosis and
treatment are discussed in Chapters 39 Inguinal Masses and 119 Genitourinary
Emergencies .

Henoch–Schönlein Purpura
Occasionally, a child may be seen with a petechial rash on the scrotum as the
initial presentation of this systemic vasculitic syndrome, characterized by
nonthrombocytopenic purpura, arthralgia, renal disease, abdominal pain, and
gastrointestinal bleeding. More typically, the rash begins on the lower extremities
or buttocks and later may involve the scrotum. If the associated swelling is not
great, the cord structures and testes can be felt to be uninvolved and normal. In
other cases with severe swelling, surgical exploration may be necessary to rule
out testicular torsion, which rarely has been noted to coexist. When skin lesions
are present, the diagnosis of Henoch–Schönlein purpura (HSP) must be
suspected. Occasionally, an acutely painful scrotum is the dominant presenting
symptom. Ultrasound may help rule out testicular torsion in these instances. For a
more detailed discussion of HSP management, see Chapter 100 Renal and
Electrolyte Emergencies .

Other Causes of a Painful Scrotum
Referred pain to the scrotum can present as acute scrotal pain without scrotal
swelling, tenderness, or mass. The somatic nerves that innervate the scrotum are
the genitofemoral, ilioinguinal, and posterior scrotal nerves. A retrocecal

appendicitis is an uncommon, but important cause of referred pain. Other
considerations may include urolithiasis, retroperitoneal processes like tumor,
lumbar, or sacral nerve compression, or pain following hernia repair.

CAUSES OF PAINLESS SCROTAL SWELLING
Hydrocele