Testicular Torsion

Kidney Stones are a Diagnosis of Exclusion!!! Introduction * Testicular torsion is a time sensitive diagnosis (risk of infertility, etc)* Commonly mimics kidney stones History * Sudden onset pain* Epididymitis tends to be slower in onset* Flank/lower abdomen/scrotal pain* Frequently causes vomiting* Uncommon in geriatric patients Exam * Perform a GU exam and look for* Unequal/horizontal “lie”* Testicular tenderness* Swelling* Absent cremasteric reflex Testing Plan * Testicular/Scrotal Ultrasound* Urinalysis Treatment Plan * Consult urology when suspected (even if ultrasound hasn’t returned yet)* Manual detorsion* “Open the Book”* Twist medial to lateral* Switch directions if no pain relief Additional Reading * Flank Pain Practice Case (EM Clerkship)* Pediatric Abdominal Pain (EM Clerkship)