Testicular torsion: The Daily PANCE Blueprint
A 15-year-old boy wakes up with sudden, severe right testicular pain. Exam shows a swollen, tender testis lying horizontally. The cremasteric reflex is absent. What is the most likely underlying cause?
A. Epididymitis
B. Trauma-induced hematoma
C. Bell clapper deformity
D. Inguinal hernia
E. None of the above
Answer and topic summary
The answer is C. Bell clapper deformity
Testicular torsion is an urologic emergency and occurs when the testicle twists around the spermatic cord, cutting off venous flow and potentially leading to ischemia of the testicle. It is more common in neonates and postpubertal boys. It typically (90% of the time) is caused by a congenital malformation of the processus vaginalis (i.e., bell clapper deformity). Sometimes it can occur spontaneously or after an event (trauma, sports, etc). Clinical features include the acute onset of testicular pain, diffuse tenderness, and a negative cremasteric reflex. A classic finding is a high-riding testis oriented transversely. Most of the time, diagnosis is clinical, but color Doppler ultrasonography can be obtained if there is uncertainty. Testicular viability decreases within 6 hours of symptom onset; therefore, prompt management is critical. Treatment for testicular torsion is surgical exploration with intraoperative detorsion and fixation of the testes. If left untreated, testicular ischemia can occur.
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