Acute Scrotum

Question 1

Outline the pathogenesis of testicular torsion

Answer 1

Attachments of the tunica vaginalis to the posterior testicular wall that occur above the testicle rather than above and below can cause the “bell-clapper” deformity where the testicle is freely mobile within the tunica and liable to torsion

Question 2

What are the risk factors for testicular torsion?

Answer 2

• Age < 25
• Neonate
• Bell clapper deformity

Question 3

What are the history/examination findings in testicular torsion?

Answer 3

• Testicular pain (often sudden, intermittent)
• N+V
• Tender, hot, swollen testicle
• High-riding, horizontal testis
• Absent cremasteric reflex

Question 4

What are the management prinicples for a person with testicular torsion?

Answer 4

• De-torsion
  
  • Manually (if surgery delayed), or via surgical exploration (orchidopexy)
• Orchiectomy if tissue damage extensive

Question 5

How might you manage a torted testicular appendage? What is the characteristic sign on examination?

Answer 5

• Blue-dot sign at superior pole of testis
• NSAIDs

Question 6

How might you manage acute epididymo-orchitis?

Answer 6

• Elevation, analgesia, empiric ABs