Many children with Henoch-Schonlein anaphylactoid purpura syndrome (HSAPS) who develop an acute scrotum have scrotal explorations to exclude torsion of the spermatic cord. However, the cause of the acute scrotum in the context of HSAPS is known to be vasculitis and not torsion. The aim of this study, therefore, was to identify factors that underlie this practice. In a 10-year retrospective study of male patients admitted to a Children's Hospital with a diagnosis of HSAPS, 22 out of the 93 children identified (22/93 = 24%) had scrotal involvement. Three children (3/22 = 14%) were investigated radiologically, eight children (8/22 = 36%) had surgical exploration and none had testicular torsion. We believe that greater awareness of the syndrome and its clinical presentation amongst paediatric surgical staff could allow the adoption of a conservative approach in children with an unequivocal diagnosis of HSAPS provided such an approach is supported by high resolution colour Doppler sonography and a fully informed parental consent. Surgical exploration is indicated if the diagnosis of the syndrome is not beyond doubt and torsion cannot be excluded on clinical grounds.