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- sudden, severe pain in one testis
- may be associated with abdominal pain, and nausea and vomiting
- 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).
- 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
- 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
- Incarcerated hernia