A 16-year-old boy is brought to the emergency department by his parents due to the sudden onset of severe right scrotal pain that awoke him from sleep 2 hours ago. He has had one episode of vomiting since the pain started. His temperature is 37.1°C (98.8°F), blood pressure is 120/78 mmHg, and pulse is 98/min. Physical examination reveals a swollen, exquisitely tender, and high-riding right testicle with a transverse lie. The right cremasteric reflex is absent. Which of the following is the most appropriate next step in management?
- Immediate surgical explorationCevap
- BScrotal Doppler ultrasonography
- CIntramuscular ceftriaxone and oral doxycycline
- DScrotal elevation and ice packs
- EUrinalysis and urine culture
Cevap
Immediate surgical exploration
The patient's presentation of sudden-onset, severe scrotal pain during sleep, accompanied by nausea or vomiting, an absent cremasteric reflex, and a high-riding testicle, is highly characteristic of testicular torsion. Testicular torsion is a urologic emergency caused by the twisting of the spermatic cord, which compromises the blood supply to the testicle. Because testicular viability decreases significantly after 6 hours of ischemia, a patient with a classic clinical picture should be taken directly to the operating room for immediate surgical exploration and bilateral orchiopexy. Delaying surgery for imaging is contraindicated when the diagnosis is highly likely.
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Testicular torsion requires emergent surgical exploration without delay for imaging when the clinical presentation is classic (sudden pain, absent cremasteric reflex, high-riding testis).