(Another one from one of the old issues – 31.7.10 – which I’m just working through.)
This article was a rather frightening reminder of some non-obvious ways in which testicular torsion can present. If I get a patient with acute-onset testicular pain, of course I know to refer them urgently for a scan – that’s medical student level stuff. But it seems that anything from 10 to 30% of patients with testicular torsion don’t get testicular pain at all. Instead they may present with abdominal pain, swelling of the testis or scrotum, and oedema or erythema of scrotal skin. Pain can be intermittent if the testis is torsioning/detorsioning. It can come on gradually as a dull ache. It can be associated with fever and positive urinalysis, thus making it look confusingly like a UTI. And, of course, it’s incredibly easy to miss in a distressed pre-verbal child who can’t tell you where it hurts.
So, what should I be doing? I suppose the only way is to do a testicular examination on everyone male who presents with abdominal pain and/or vomiting, and on every baby boy presenting with general distress. And I may have to be willing to push some dubious referrals past surgical F2s convinced that it’s all a load of bollocks.