Testicular Torsion: The Daily PANCE Blueprint
A 14-year-old male presents to the ER with worsening unilateral scrotal pain and swelling. The left testicle is tender to palpation on exam. Doppler US reveals decreased overall blood flow. Which of the following is the best overall management option?
A. Emergent surgery
B. IV antibiotics
C. I&D
D. Manual detorsion
E. Ice packs
Answer and topic summary
The answer is A. Emergent surgery
Testicular torsion is a urologic emergency that occurs when the testicle twists around the spermatic cord, cutting off blood flow and potentially leading to ischemia. 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. It can occur spontaneously or after an event (trauma, sports, etc.). Clinical features include acute onset of testicular pain, diffuse tenderness, and negative cremasteric reflex. A classic finding is a high-riding testis oriented transversely (bell clapper deformity). Most of the time, diagnosis is clinical, but color Doppler ultrasonography can be obtained if there is uncertainty (however, it’s not a perfect test). 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.
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