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Scott,
Difficult case all the way around. I agree with Dr. Cooper that Doppler's can be falsely negative but this is usually the case in the prepubertal patient. Having said that, a reactive hydrocoel may be viewed as an indirect clue to ischemia or inflammation. When this information is combined with a good history, in the right age group, as in this case, some would argue that at least a discussion with a urologist is warranted. Do you know if this had occured? Hindsight is always 20/20, but I would not have done anything differently. 
Regards
Jay
Le Bonheur Children's
{Jay Pershad, MD, FAAP, FACEP} 




________________________________
From: Scott Freedman <[log in to unmask]>

..Your opinions please:

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.

Thank you.
-- 
Scott H. Freedman, MD

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