Vignette says a 21 year old male presents to the emergency department with a sudden onset of severe testicular pain, that started 6 hours ago while playing basketball; The pain is sudden in onset, severe in intensity and localized to the right testicle; He also reports nausea but no vomiting; Genital examination shows swollen, erythematous and tender right sided scrotum; Cremasteric reflex is absent; Vital signs show blood pressure of 110/80 mm of Hg, pulse rate of 88 bpm, respiratory rate of 16 breaths/min, oxygen saturation of 98% in RA and temperature of 96.7F; He has no significant medical or surgical history; Doppler ultrasonography shows absence of testicular blood flow; Diagnosis?
Diagnosis is testicular torsion.
Presents with acute onset severe testicular pain along with swollen, erythematous scrotum; Associated with congenital inadequate fixation of testis to tunica vaginalis → horizontal positioning of testes (“bell clapper” deformity); Prehn sign is negative (i.e. failure to relieve pain upon lifting the scrotum) and cremasteric reflex is absent (i.e. failure of the scrotal skin to retract upon palpation of the medial thigh).
Diagnosis:-
1. Doppler ultrasonography shows absence of testicular blood flow.
Management:-
1. Surgical detorsion and fixation (orchiopexy) within 6 hours; Manual detorsion (if immediate surgery is not available.
2. Orchiectomy (if testis is not viable).