History
Testicular Torsion
• Sudden onset pain (± swelling) in scrotum w/ radiation into abdomen; pain may be intermittent; N/V; most commonly in puberty
Torsion of Appendix
• Similar presentation to testicular torsion but pain can be localized to superior pole of testicle; benign condition
Physical Exam
Testicular Torsion
• Ill appearing, very tender/swollen/elevated testicle that may lie horizontally or anteriorly rotated; no relief w/ elevation of testicle (negative Prehn sign); ipsilateral loss of cremasteric reflex
Torsion of Appendix
• Normal-appearing testes; tenderness localized to superior pole of testicle; may have nodular “blue dot” at superior pole of testicle
Evaluation
• Labs: Preop labs if surgery anticipated
• Imaging: Scrotal duplex U/S to assess flow to testicle, but imaging should not delay time to OR; HRUS if duplex equivocal
Treatment
• Consult urology immediately if concern for testicular torsion as time to OR is critical for survival of testicle; if delay to OR, may attempt manual detorsion in medial to lateral direction (‘open book” technique)
• Analgesia
• Antiemetics
Pearls
• 100% salvage rate if detorsion occurs <6 h
• Continuous pain >24 h is a/w an infarcted testicle