Objective <p>Acute scrotal pathologies are characterized by sudden onset of pain, swelling, and redness in the scrotum. This condition is commonly observed in male patients presenting to emergency departments. Prompt diagnosis and treatment are crucial for effective management of this condition. The objective of this study is to evaluate the etiology, clinical presentation, sociodemographic characteristics, and timelines for presentation, diagnosis, and treatment in boys diagnosed with acute scrotum.</p> Study design <p>This retrospective study reviewed the files of male patients under the age of 18 who were admitted to our pediatric emergency department between July 2019 and July 2024 with a diagnosis of acute scrotum. The data collected encompassed a wide range of information, including sociodemographic characteristics, the etiology of acute scrotum, the presenting complaints, the physical examination findings, the time interval from the onset of symptoms to presentation, imaging studies, and surgical consultations.</p> Results <p>A total of 151 cases were identified, with ages ranging from 0 to 17&#xa0;years. The etiologies included epididymitis (<i>n</i> = 43), torsion of the appendix of the testis (<i>n</i> = 33), testicular torsion (<i>n</i> = 28), scrotal cellulitis (<i>n</i> = 23), incarcerated/strangulated inguinal hernia (<i>n</i> = 15), trauma (<i>n</i> = 8), and Henoch-Schönlein purpura (<i>n</i> = 1). The most prevalent presenting complaints were swelling (<i>n</i> = 39, 30.7%) and pain (<i>n</i> = 36, 28.3%). While the time to presentation and imaging were similar across cases, surgical consultation was significantly faster for patients with testicular torsion.</p> Conclusion <p>In pediatric emergency settings, acute scrotum necessitates meticulous evaluation. Early diagnosis and timely intervention are imperative to avert complications, including testicular loss, and to ensure the patient’s well-being.</p>