Testicular Torsion

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)