TESTICULAR TORSION

Question 1

Symptoms

Answer 1

Nausea
Vomiting
Abdominal Pain
Testicular Pain

Question 2

Physical Exam

Answer 2

Include a testicular exam in males presenting with abdominal pain or vomiting:

elevated testicle
absent cremasteric reflex
swollen, diffusely tender or erythematous
transverse lie
Bell Clapper Deformity

Question 3

DDx

Answer 3

Appendicitis
Testes Torsion
Acute Epididymitis
Testes (or epididymal) appendage torsion
Incarcerated inguinal hernia

Question 4

Workup

Answer 4

If clinically obvious consult Urology prior to investigations

If torsion is suspected and clinical suscpiciojn is high, consult Urology

Ultrasound with colour doppler flow

Question 5

Management

Answer 5

Surgical Emergency, consult to urology
Best outcomes if treated within 6 hours
> 24 hours unlikely to salvage
Manual detorsion “Open Book” can be used as a temporizing maneuver if definitive surgical management is delayed

Question 6

Manual detorsion “Open Book” steps

Answer 6

Consider pain medication and sedation
Place patient in supine position
Hold testes between thumb and forefinger
Rotate testes from medial to lateral 180 degrees
Repeat 2-3 times until detorsion is complete and pain resolves