TESTICULAR TORSION

Question 1

DDx: Painful Scrotum

Answer 1

Trauma
Testicular Torsion
Testicular (or epididymal) appendage torsion

Acute Epididymitis
Orchitis
Appendicitis

Incarcerated inguinal hernia
Varicocele

Question 2

Clinical Features

Answer 2

Testicular Pain
Abdominal Pain
swollen, diffusely tender or erythematous
elevated testicle

A/W:
Nausea
Vomiting

Question 3

Risk Factor

Answer 3

Bell Clapper Deformity

Question 4

Physical Exam

Answer 4

absent cremasteric reflex - most sensitive finding

Question 5

Investigations

Answer 5

If clinically obvious consult Urology prior to investigations

If torsion is suspected and clinical suscpiciojn is high, consult Urology

Ultrasound with colour doppler flow if equivocal

Question 6

Management

Answer 6

Surgical Emergency, consult to urology
Best outcomes if treated within 6 hours
> 24 hours unlikely to salvage
Manual detorsion “Open Book” can be used as a temporizing maneuver if definitive surgical management is delayed

Question 7

Manual detorsion “Open Book” steps

Answer 7

Consider pain medication and sedation
Place patient in supine position
Hold testes between thumb and forefinger
Rotate testes from medial to lateral 180 degrees
Repeat 2-3 times until detorsion is complete and pain resolves