Patient case: Testicular Torsion
A 16-year-old male presents to the emergency department with sudden-onset, severe right scrotal pain that started approximately 4 hours ago. The pain is sharp and constant, and it has progressively worsened. He denies any recent trauma or injury to the area. The patient also reports nausea and vomiting, but no fever or difficulty urinating.
On physical examination, the right scrotum is swollen, erythematous, and significantly tender to touch. The patient’s right testis is elevated, and the scrotum appears more asymmetrical compared to the left side. The cremasteric reflex on the right side is absent. The left testis appears normal, and there is no inguinal hernia or other abnormalities noted.
Given the acute onset of severe pain and physical findings, testicular torsion is suspected. An urgent scrotal ultrasound with Doppler is performed, which reveals absent blood flow to the right testis, confirming the diagnosis of testicular torsion.
The patient is immediately taken to the operating room for a detorsion procedure to save the testis. After successful surgery, the testis is repositioned and fixed to prevent recurrence. The patient is advised to avoid strenuous physical activity and is scheduled for follow-up to monitor recovery.
A) Painful urination
B) Sudden-onset severe scrotal pain
C) Fever and chills
D) Blood in the urine
A) Swollen and non-tender scrotum
B) Elevated testis and absent cremasteric reflex
C) Redness and bruising on the scrotum
D) Painful, palpable mass in the scrotum
A) Urine culture
B) Scrotal ultrasound with Doppler
C) CT scan of the abdomen and pelvis
D) X-ray of the pelvis
A) Antibiotics and pain management
B) Observation and follow-up
C) Surgical detorsion and testicular fixation
D) Oral anti-inflammatory medications
