Word has gotten out that chest pain is an emergency. Stroke symptoms are on our radar, too, thanks in part to the “Time is Brain” stroke campaign. We generally hustle to the ER for severe abdominal pain, shortness of breath or dehydration. Scrotal pain, however, is another story.
Torsion of the testicle is not the only cause of acute scrotal pain, but it is the one that emergency physicians cannot afford to miss. Unfortunately, this condition comes with an impressive number of tripwires capable of bringing down even the most experienced clinicians...
There are some methods of conservative treatment a surgeon may take to untwist the testicle manually but, in most cases if there is a loss of blood flow and ongoing pain the only way to be sure that the testicle is untwisted is via surgical exploration.
Pain is not normal in the testes. It can't wait. If your boy has pain in his testes, take him to the Emergency Room right away, not to the doctor or to urgent care. The Emergency Room has the ultrasound machine to diagnose testicular torsion, and the testes is at risk of dying if you do not act quickly.
•Testicular torsion is a true surgical emergency
•Do not neglect the inguino-scrotal exam in the inconsolable infant
•No part of the history or clinical exam can rule out torsion with 100% reliability
•Doppler US can aid diagnosis in equivocal cases but if not immediately available should not prevent a trip to the OR
In this review, long-held myths and misperceptions about
the evaluation and management of testicular torsion are discussed, and
recommendations for the management of patients who present with
acute scrotal pain are presented.
Although torsion of the testicle can occur at any age, it is most common in young boys and young men between the ages of 12 and 18. The chief compliant is the sudden onset severe pain in one testicle. It usually begins after exercise but can occur when the boy is at rest or even awaken the boy from sleep.
Torsion is most common in the first year of life (including the prenatal period) and at puberty, although it can occur at any age. Patients often describe fairly sudden, severe unilateral testicular pain, sometimes radiating into the abdomen, associated with nausea and vomiting. They may also report urgency, frequency, and dysuria. The left testicle is more frequently affected.
Extensive professional reference.
Surgery is required to correct testicular torsion. In some cases, the doctor might be able to untwist the testicle by pushing on the scrotum (manual detorsion). But you'll still need surgery to prevent torsion from occurring again.
Some men are more prone to this condition because of defects in the connective tissue within the scrotum. The problem may also occur after an injury to the scrotum that results in a lot of swelling or following heavy exercise. In some cases, there is no clear cause.
The condition is more common during the first year of life and at the beginning of adolescence (puberty). However, it may happen in older men.
The testicle can twist and tighten up around the spermatic cord. The twist can happen outside of the scrotum, normally at the external inguinal ring, or inside of the scrotum. Inside is more common, especially in adolescents and young adults, especially if there is a bell clapper deformity. In 5-8% of cases, this twisting is triggered by mild or moderate trauma.
•There is usually reddening of the scrotal skin.
•There is a swollen, tender testis retracted upwards.
•Lifting the testis up over the symphysis increases pain, whereas in epididymitis this usually relieves pain.