Testicular torsion

Last Updated on by FRCEM Intermediate

Symptoms

  • sudden, severe pain in one testis
  • may be associated with abdominal pain, and nausea and vomiting

Examinations Findings

  • swollen, tender testis
  • testes retracted upwards (high riding testes),
  • horizontally lying testes- (the bell clapper position)
  • Reddening of scrotal skin, Scrotal edema and or a reactive hydrocele may be present
  • loss of cremasteric reflex (an immediate contraction of the cremaster muscle that pulls up the testis ipsilaterally).

Investigations

  • Clinical Diagnosis
    • Testicular salvage most likely occurs if the duration of torsion is less than six hours. If it exists for 24 hours or more, testicular necrosis is usual.
  • US testes

Management

  • Analgesia: intranasal Diamorphine / Morphine
  • Urgent In-Patient referral to the Urology team for surgical management (scrotal exploration) within the next 6 hours

The differential diagnosis

  • Torsion of the testicular or epididymal appendage
  • Epididymo-orchitis
  • Trauma
  • Incarcerated hernia
  • Mumps

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