well...regarding any testicular torsion, I myself never discharge any
patient out of my department before thinking 100 times...after what I've
seen the number of cases of necrosis , and I was feeling sad and scared of
this even more than the MI itself.
For 12 years boy I doubt how the sonographist can assure 100 % that the
vascular supply is intact ?? and even so, the recent update for torsion
testes is to OPEN and only OPEN....
just one other point.how many hours you kept the boy in ER at the first
time?? I think at least 6 hours should pass before discharge him...to
witness any chance of further attacks..its a serious issue..
----- Original Message -----
From: "Scott Freedman" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, March 31, 2009 12:51 AM
Subject: case opinion- testicular torsion
> ..Your opinions please:
> We recently treated a 12 year old boy with acute scrotal pain- who
> acute onset, severe one sided scrotal pain and swelling for approx 3
> 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
> discharge instructions for when to return, does anyone have guidelines on
> dealing with this differently?. Do the urologists admit these kids at
> visit with "normal flow"- (ours don't)? Is there information on risk of
> time period for predicted recurrence? Any other thoughts or information
> here. Was this just a very unfortunate circumstance...the patient
> the recurrence of symptoms was only a couple hours prior to returning.
> Thank you.
> Scott H. Freedman, MD
> Medical Director, Pediatric Emergency Medicine
> (240) 826-7017
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
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