EM Clerkship

Testicular Torsion

08.26.2018 - By Zack Olson, MD and Michael Estephan, MDPlay

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Kidney Stones are a Diagnosis of Exclusion!!!

Introduction

* Testicular torsion is a time sensitive diagnosis (risk of infertility, etc)* Commonly mimics kidney stones

History

* Sudden onset pain* Epididymitis tends to be slower in onset* Flank/lower abdomen/scrotal pain* Frequently causes vomiting* Uncommon in geriatric patients

Exam

* Perform a GU exam and look for* Unequal/horizontal “lie”* Testicular tenderness* Swelling* Absent cremasteric reflex

Testing Plan

* Testicular/Scrotal Ultrasound* Urinalysis

Treatment Plan

* Consult urology when suspected (even if ultrasound hasn’t returned yet)* Manual detorsion* “Open the Book”* Twist medial to lateral* Switch directions if no pain relief

Additional Reading

* Flank Pain Practice Case (EM Clerkship)* Pediatric Abdominal Pain (EM Clerkship)

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