..Your opinions please:
We recently treated a 12 year old boy with acute scrotal pain- who described
acute onset, severe one sided scrotal pain and swelling for approx 3 hours.
Upon arrival and placement to an ED room, the child stated the pain 'was
gone". he had minimal swelling and no tenderness. First on differential
diagnosis was acute testicular torsion that spontaneously de-torsed. A
testicular sono demonstrated normal testicular flow and a small (?reactive
vs traumatic) hydrocoele. The child had an appt scheduled with a
urologist the next afternoon. He returned to the ED the following morning
with reportedly 2 hours of pain. The scrotum was indurated and tender
and in the OR, the testicle was necrotic.
We know that torsion- detorsion occurs. Other than providing hyper-vigilant
discharge instructions for when to return, does anyone have guidelines on
dealing with this differently?. Do the urologists admit these kids at first
visit with "normal flow"- (ours don't)? Is there information on risk of and
time period for predicted recurrence? Any other thoughts or information
here. Was this just a very unfortunate circumstance...the patient insisted
the recurrence of symptoms was only a couple hours prior to returning.
Scott H. Freedman, MD
Medical Director, Pediatric Emergency Medicine
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