Daily Bolus of LR: Testicular Torsion

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June 14, 2011 by dailybolusoflr

Testicular Torsion

· Testicular torsion is most commonly seen in males under the age of 25

· 90% of cases are caused by a congenital abnormality, known as a “Bell Clapper” deformity

· Most cases occur without any clear precipitating event, although a small amount are related to trauma

· If detorsion occurs in under 6 hours, there is a 90% salvage rate for the testicle

o If torsion is highly suspected or is clinically discovered on ultrasound (diagnostic test of choice) and the patient is not urgently going to the OR, manual detorsion can be attempted

o This involves turning the testicle outward (medial to lateral), like opening a book. It is recommended to turn twice (two 180 degree turns, as the testicle can torse more than 180 degrees)

· The most sensitive finding of concern for torsion is the loss of a normal cremasteric reflex on the affected side.

o This reflex is elicited by stroking or pinching the medial thigh, which causes contraction of the cremaster muscle

o This results in elevation of the testis and is considered normal if it raised at least 0.5 cm

Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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