Question of the Week # 245

245 )  A 52-year-old man presents with acute onset of pain in his left testis which started abruptly after unprotected sexual intercourse. The pain started 3 hours ago, it is severe and constant. He denies any fever, chills, nausea or vomiting. On physical examination, the patient is afebrile and in severe distress. Testcular examination reveals a normal sized diffusely tender left testicle. Cremasteric reflex is absent on the left. A routine testicular ultrasound reveals normal testicles. A Complete Blood Count and Urinalysis are normal. What is the next step in management of this condition?

A)     Observation and Antibiotics

B)      Surgical exploration

C)      Repeat Testicular Doppler Ultrasound

D)     Laparotomy

E)      Observation alone

16 Responses

  1. B is the answer.
    this pt has testicular torsion which is an surgical emergency.

  2. cccccccccc

  3. c

  4. B. Testicular torsion is an surgical emergency.. must salvage it within 6 hours..

  5. per medscape “Early in the course of testicular torsion, gray-scale ultrasonographic examination may be absolutely normal.”…

  6. B. :
    absent Cremasteric reflex >> Torsion >> surgical explor.

  7. B…. Cremasteric reflex is absent and diffusely tender testicle. 99% sensitivity of testicular torsion. Do not use this test under age 30 months

  8. bbb

  9. Anser : surgical exploration

    No point in repeating the U.S in later time . Patient’s testes is at risk here . The longer you wait , the worse it gets . Reactive hyperemia might be there for some time . So repeating an doppler U.S might give you a negative result .

    Sudden onset of severe testical pain = red flag for torsion .
    Epididymitis does not occur abruptly .

    Cremastric reflex absent : is pretty good enough to make the diagnosis .

  10. diagnose of torsion is absolutely clinical and there is no reason to do u/s even for once
    mng is Emer surgery

  11. B

  12. B)

  13. Onset of pain less than 6 hours, absence of cremasteric reflex, and diffuse testicular tenderness. Out of 141 subjects, in the absence of any of these elements, none of the subjects had testicular torsion. With all 3 elements present, 87% were diagnosed with testicular torsion.[3]

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