The authors discuss different forms of acute scrotal syndrome in child age, its symptomatology, differential diagnosis and treatment. They emphasize in particular the importance of the time factor in torsion of the testis and the necessity of urgent surgery and the difficulty of differential diagnosis. Final treatment of children with acute scrotal syndrome should therefore be provided in time in a department with sufficient experience with this problem. In the department of paediatric surgery in the Thomayer Faculty Hospital in Prague during the four-year period (1992-1995) a total of 88 children with acute scrotal syndrome were treated. Inflammatory diseases predominated (39%), torsion of the testicular and epididymal appendages was recorded in 28%, and torsion of the testis in 14%. Children with testicular torsion came to the hospital on average 20 hours after the onset of symptoms, all were operated but only 58% of the testes were saved.