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CT scan of abdomen and pelvis
5%
1/20
IV antibiotics
Observation and morphine
50%
10/20
Surgical exploration
20%
4/20
Testicular doppler ultrasound
10%
2/20
Select Answer to see Preferred Response
This patient is presenting with abdominal pain, vomiting, an absent cremasteric reflex, and an elevated testicle concerning for testicular torsion. This is a surgical emergency and the patient should be taken directly to the operating room without delay in order to save the testicle. Testicular torsion presents with sudden onset and severe abdominal and testicular pain. On physical exam, the most accurate diagnostic sign is an absent ipsilateral cremasteric reflex; however, other findings include an elevated testicle with a horizontal lie. Any patient for whom there is a clinical picture supporting a diagnosis of testicular torsion should next be managed with emergency surgery. Other possible steps in the workup of testicular torsion include an ultrasound with Doppler; however, this test should never be performed if it will delay surgical intervention. Manual detorsion can be attempted if there is any delay in emergency surgery. Incorrect Answers: Answer 1: CT scan of the abdomen and pelvis could be indicated in the workup of appendicitis which presents with right lower quadrant abdominal pain with a positive Rovsing sign but would not be appropriate in this surgical emergency. Answer 2: IV antibiotics would be appropriate for epididymitis which presents with a tender posterior testicle with pain sometimes relieved by elevation of the testicle (Prehn sign). Fever and pyuria can also be seen in this condition and the pain is not sudden onset and severe. Answer 3: Observation and morphine is appropriate management if a patient is only having pain without a life-threatening diagnosis warranting treatment. Testicular torsion is a surgical emergency as the more time that passes the more likely it is that the testicle suffers permanent ischemic damage. Answer 5: Testicular Doppler ultrasound would be an appropriate confirmatory diagnostic test and could demonstrate decreased blood flow to the testicle. It would not be appropriate in a patient with a classic presentation of testicular torsion as it could delay surgical intervention. Bullet Summary: Emergency surgery is the best initial step in management in testicular torsion.
5.0
(9)
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