How long do you have?
A 14-year-old boy woke 2 hours ago with sudden severe pain in his left testis, spreading to his lower tummy, and he has vomited. The testis sits high and lies horizontally.
What's the diagnosis, and should you wait for an ultrasound?
Pick the diagnosis
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The title is a big hint. This is a race against the clock.
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Testicular torsion. No: straight to theatre
- What's going on
- The testis twists on its spermatic cord and cuts off its own blood supply. In “bell clapper” anatomy the testis hangs freely inside its covering, like the clapper of a bell. This is often present on both sides.
- Spot it
- Sudden severe pain, often with nausea and vomiting. A high-riding, horizontal testis and an absent cremasteric reflex. It can present as lower abdominal pain, so always examine the testes.
- Test
- It's a clinical diagnosis. If torsion is suspected, don't delay surgery for an ultrasound.
- Treatment
- Urgent scrotal exploration: untwist the testis and fix it, or remove it if it has died. Always fix the other side too.
- Why it matters
- Over 90% are saved within 6 hours of the pain starting. The odds fall steeply after that.
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Tap a question to check your answer.
Why the rush?
The twisted cord cuts off the blood supply. Over 90% are saved within 6 hours.
Would you get an ultrasound first?
No. If torsion is suspected, don't delay surgery for a scan.
Why check the testes in a boy with tummy pain?
Torsion can present as lower abdominal pain.
What's a “bell clapper” testis?
One that hangs freely inside its covering, so it can twist.
Harder: why fix the other side too?
The same anatomy is often present on both sides.
Source: Patient.info Professional · RCEMLearning
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