Testicular Torsion

In Agony 2

Step 1: View clinicals

A 45 year old man presents with severe lower abdominal pain for 2 hours, in association with nausea and vomiting. No other symptoms are present. Close questioning reveals a history of similar but much milder episodes of pain for many years, all of which resolved spontaneously without treatment. His medical, surgical, and family histories are otherwise unremarkable.

Step 2: Order all relevant investigations

Urine Cultures

Culture results will be available in 48 to 72 hours.

Color Doppler Scrotum

The color doppler sonogram shows absence of blood flow to the left testis. The right testis demonstrates normal blood flow.

Ultrasound Abdomen

The ultrasound scan of the abdomen shows no abnormalities.

Scrotal Scintigraphy

Scrotal scintigraphy demonstrates markedly decreased uptake of technetium-99m into the left testis.

Step 3: Select appropriate management

Opioid Analgesics
Oral Fluoroquinolones
L/s Orchidectomy
R/s Orchidopexy

Score: ★★☆