Acute scrotum a dilemma in a 21-month child: a case report.

Introduction: Acute scrotum in young children presents a diagnostic challenge, as clinical assessment is often limited and symptoms may be nonspecific. Although scrotal trauma is uncommon, it can be associated with serious underlying conditions such as testicular fracture or torsion. Early identification and timely surgical intervention are critical to prevent testicular loss. Case presentation: We report the case of a 21-month-old toddler boy who presented with left scrotal pain and swelling following minor blunt trauma. Ultrasonography revealed a loculated collection, and absent vascularity in the left testis, suggestive of testicular fracture. Due to suspicion of testicular rupture, emergency scrotal exploration was performed. Intraoperatively, the patient was found to have left testicular torsion. The testis was nonviable, and a left orchidectomy was carried out. Discussion: Traumatic testicular torsion is a rare but important differential diagnosis in pediatric acute scrotum. Ultrasonography is valuable for initial evaluation; however, overlapping features may lead to diagnostic uncertainty. Surgical exploration remains essential when rupture or torsion is suspected. Conclusion: This case highlights the importance of maintaining a high index of suspicion for testicular torsion in children presenting with acute scrotum after trauma. Prompt evaluation and early surgical intervention are crucial to optimize outcomes.