The scrotum is a skin and fibromuscular sac containing the testicles, epididymis and the lower part of the funiculus spermaticus. Acute scrotum is a term that includes a wide spectrum of diseases. According to the etiology, we distinguish between inflammations (epididymitis, epididymorrhitis, orchitis, testicular abscess, Fournier's gangrene), circulatory disorders (torsion of the testicle and testicular appendix, incarcerated inguinal hernia), trauma (haematocele, testicular rupture) and other, rare causes (scrotal edema, Hennoch Schoenlein purpura and others). Acute epididymitis is the most common cause of scrotal pain in adults. The main symptom is usually the gradual onset of pain from the back of the scrotum along with swelling of the epididymis and testicles, and the scrotum is edematous and reddish. The classic clinical presentation of testicular torsion is usually sudden onset, severe, unilateral pain, often accompanied by nausea and vomiting. The biggest diagnostic problem is differentiating acute epididymitis from testicular torsion, but other possible causes should also be considered. Necrosis and loss of the testicle can occur as early as 6 hours after the onset of ischemia, therefore, if, based on the history and physical examination, we suspect testicular torsion, immediate surgical exploration is mandatory. To make a diagnosis, an anamnesis and a physical examination are often sufficient, and an ultrasound with color-Doppler sonography is indispensable.