Which finding suggests a surgical emergency?

• A. Unilateral swollen scrotum that is bluish red
• B. Bilateral mild scrotal swelling
• C. Fever with rectal temperature elevation
• D. Umbilical hernia that reduces spontaneously

Answer: (A)

Unilateral scrotal swelling with bluish-red discoloration points to testicular torsion, a surgical emergency. Twisting of the spermatic cord cuts off blood flow to the testicle, so salvaging the testis depends on rapid evaluation and prompt detorsion. The color change reflects urgent ischemia, and delaying to obtain imaging can reduce the chance of saving the testicle.

In contrast, bilateral mild scrotal swelling is often due to non-emergent causes like hydrocele or edema. Fever with an elevated temperature suggests infection rather than torsion and requires infectious workup and treatment rather than urgent scrotal exploration. An umbilical hernia that reduces spontaneously is typically reducible and managed conservatively or electively, not as an emergency.