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Testicular torsion

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High Yield Notes

15 pages

Flashcards

Testicular torsion

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Preguntas

Preguntas del estilo USMLE Step 1

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A 17-year-old boy is brought to the emergency department for evaluation of acute right-sided scrotal pain with associated nausea and vomiting. The patient was playing football when he felt sudden pain following a tackle to the abdomen. The patient has tried over the counter analgesia and ice pack placement over the groin without relief of symptoms. He has had similar episodes of pain that self-resolved after 30 minutes. He has no significant past medical history and has received all age-appropriate vaccinations. Temperature is 37.0°C (98.6°F), pulse is 99/min, respirations are 21/min, and blood pressure is 145/80 mmHg. Physical examination reveals an uncomfortable adolescent in significant pain. Examination reveals an edematous and erythematous right scrotum that does not transilluminate. Stroking of the right inner thigh does not result in elevation of the right testis. The pain is worsened with elevation of the scrotum. Which of the following is the most likely etiology of this patient’s clinical condition?

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External References

First Aid

2024

2023

2022

2021

Testicular torsion p. 669

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Resumen

Testicular torsion is a medical emergency that occurs when the testicle twists on its spermatic cord, cutting off the blood supply to the testicle, which can lead to ischemia. The principal symptom is rapid onset of testicular pain. The most common underlying cause in adolescents and neonates is a congenital malformation known as a "bell-clapper deformity" wherein the testis is inadequately affixed to the scrotum allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels. Testicular malignancy is the most common cause in adults.

Symptoms include sudden onset of severe pain in one testicle, often accompanied by swelling and tenderness, there may also be nausea and vomiting, abdominal pain, and a high-riding testicle. Diagnosis is clinical, with a scrotal ultrasound for confirmation. Treatment may require emergency detorsion, which can be done manually, or surgically if the former is not possible