INTRODUCTION Acute scrotum is defined as the acute onset of pain and swelling of the scrotum that requires either emergency surgical intervention or specific medical therapy. Several acute scrotal conditions can present in a similar way, torsion of testes being the most significant. It is a true surgical emergency because the likelihood of testicular salvage decreases as the duration of torsion increases. The other conditions that present as an acute condition include torsion of appendix of testis, epididymo–orchitis, testicular trauma, hematocele, strangulated inguinal hernia and Fournier’s gangrene. A combined background information and physical findings frequently suggest correct diagnosis along with appropriate use of imaging studies. Despite of all the investigations, early scrotal exploration remains to be the main stay of diagnosis, as well as therapeutic modality. OBJECTIVES This study was conducted to ascertain various types of acute scrotal conditions, study the pathology, presentation, management of different conditions and to evaluate the efficacy of investigations in the management. RESULTS: Among the 50 patients included in the study, epididymo–orchitis was found to be the commonest condition followed by Fournier’s gangrene and then testicular torsion among acute scrotal conditions. Maximum incidence occurred during the third decade. Acute scrotum was found to be more common in populations involved in strenuous work and factors like trauma dn urinary symptoms had a definite effect in acute scrotum. Scrotal swelling associated with pain was the commonest symptom followed by fever and burning micturition. Unilateral involvement on the right side was more common. Ultrasound of scrotum was found to be the most sensitive investigation with other investigations being supportive. None of the patients developed complications and all of them responded to treatment specific to the condition, either conservative, medical or surgical and follow up for six months was uneventful. CONCLUSION: Acute scrotum is common in younger individuals with variable symptomatology. They need careful examination, proper evaluation and prompt treatment for testicular salvage. Conservative treatment is more effective in cases of epididymo–orchitis and idiopathic scrotal edema. Emergency surgical exploration proved to be the best in cases of torsion testis and Fournier’s gangrene. Ultrasound scrotum proved to be the best investigative modality, as definite diagnosis can be reached in almost every case of acute scrotum. As acute scrotum may affect the entire life of patients in form of sterility, appropriate investigations, diagnosis and timely, if need be, aggressive treatment is needed.