Several acute scrotal conditions can present in similar way, testicular torsionis by far the most significant. Testicular torsion is a true surgical emergency because, the likelyhood of testicular salvage decreases, as the duration of torsion increases. Other conditions that presents in similar way to testicular torsion include, torsion of appendix testis, epididymo-orchitis, trauma to testis, haematocele, strangulated inguinal hernia, HenochSchonlein purpura etc. A variety of investigations have been described in the management of acute scrotal conditions. These include an array of tests from a simple urine examination to more sophisticated forms like ultrasonography, Doppler studies and radionucleotide scanning. In case of epididymo-orchitis conservative approach yields good results and prevents complications. But ultimately for acute scrotum scrotal exploration remains as gold standard approach. Aim: To study clinical presentation, differential diagnosis and management of acute scrotum. METHODOLOGY: Prospective study, in Department of general surgery, Government General Hospital, Kadapa from 22nd december 2018 to 21st december 2020 in 100 cases. RESULTS: In present study most common condition is epididymo-orchitis with 35 cases(35%) followed by fournier’s gangrene30(30%), Pyocele16(16%), haematoma 10(10%), torsion 8(8%) and scrotal wall abscess 1(1%). Symptom wise pain and swelling were the presenting complaints in all the patients involved in the study. CONCLUSION: Torsion is common in younger age group. Epididymo-orchitis is common in young and middle age groups where as fournier’s gangrene was common in elderly age groups. USG colour Doppler should be done in all cases except in clinically obvious cases of Fournier’s gangrene. Conservative management is the main stay of treatment in the case of epididymo-orchitis. Thorough debridement followed later by graft cover orsecondary suturing is effective treatment in case of fournier’s gangrene