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You are seeing a 14 year old boy who presents with sudden onset of left scrotal pain and swelling, starting 4 hours prior to presentation. He has had a cold recently, but no fever. He fell off his bike yesterday but did not think he had any injuries beyond a scraped knee. Which of the following aspects of his presentation is not consistent with testicular torsion?
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January 7, 2022 at 3:35 pm
C) Elevating and supporting his left scrotum with your hand relieves the pain
This is known as Prehn’s sign, and is associated with epididymitis. Sudden onset scrotal pain, nausea & vomiting, negative cremasteric reflex (stroking the inner thigh causes the testicle to rise), scrotal pain radiating to the lower abdomen, and an abnormal horizontal “lie” to the affected testicle, are all consistent with testicular torsion. Testicular torsion is a surgical emergency, and viability falls significantly between the 6th and 12th hour or unresolved torsion. ED physicians can attempt manual detorsion (“open book method”) and should consult a urologist immediately if torsion is highly suspected; urology consultation should not be delayed for imaging (typically color Doppler scrotal ultrasound).