#EMConf: Testicular Torsion
Epidemiology - Peak incidence in first year of life and during puberty; Can occur at any age.
Mechanism - 50% occur during sleep; Can occur during trauma as well.
Risk factors - Bell-clapper deformity or undescended testes.
- acute onset testicular pain, associated nausea and vomiting.
- can present with isolated lower abdominal pain or flank pain.
- exam findings are not very sensitive
- cremasteric reflex
- phren's sign does not rule out torsion
- swollen testes, transverse lie.
- blue dot sign pathognomonic for torsion of appendix testis.
- History and physical exam are insufficient to rule out testicular torsion - ultrasound.
- stat urology consult.
- consider manual detorsion depending on urology consultation.
How We Miss Torsion:
- One of the four most common sources of pediatric malpractice litigation.
- Failing to recognize it can occur after puberty.
- atypical presentations like lower abdominal pain.
- not examining the testicles in every GU and lower abdominal pain complaint.
- false negative torsion is a common theme in litigated and missed torsion cases - if negative ultrasound but high clinical suspicion consult urology.