diagnosis 27

Andrew is a 17-year-old Caucasian male who has been seen routinely at the clinic since birth presents with his mother with severe right groin and scrotal pain that has persisted for the past four hours. He also complains of nausea but no fever or vomiting. He is currently sexually active.

Sharp and constant right groin pain x4 hours

Denies fever or vomiting

Radiating pain to right scrotum

Sexually active x1 year, uses condoms

Pain started after playing football

Denies dysuria, urethral discharge, frequency

Swollen, tender, erythematous right scrotum

Denies abdominal pain

10/10 pain scale

No steroids, dietary supplements, no smoking

No palpable mass to right scrotum

Nausea

No penile discharge, inguinal lymphadenopathy, or hernias

Nothing has relieved the pain

Negative Prehn sign, absent blue dot sign

Had similar pain a few months ago, relieved without any treatment

Absent cremasteric reflex on the right

No transillumination of the scrotum

Andrew is a 17-year-old Caucasian sexually active male with a history of viral gastroenteritis, upper respiratory infection, appendectomy, and behavioral problems. Four hours ago, while playing football, he experienced a sudden onset of severe right groin pain radiating to the right scrotum, for which he now seeks medical attention. He reports that the pain was intermittent at initially but has been consistent and severe over the past couple of hours. On a scale from 0 to 10, he rates the pain as a 10 out of 10. Six to nine months ago, the patient experienced a similar incident that spontaneously resolved. He has accompanying nausea, although he denies vomiting and fever.

Severe groin and scrotal pain

Swollen, tender, erythematous right scrotum

Acute onset of severe pain

Swollen, tender, right testicle without mass

Occurred after playing football

10/10 pain scale

Pain radiating from right groin to right scrotum

Negative Prehn sign, absent blue dot sign

Nothing alleviates the pain

Absent cremasteric reflex on the right

No past trauma to groin area

No transillumination of the scrotum

Prior episode, resolved on its own

No palpable mass to right scrotum

Sexually active male

No penile discharge, inguinal lymphadenopathy, or hernias

Severe groin and scrotal pain

Swollen, tender, erythematous right scrotum

Pain radiating from right groin to right scrotum

Swollen, tender, right testicle without mass

Occurred after playing football

10/10 pain scale

Prior episode, resolved on its own

Negative Prehn sign, absent blue dot sign

Nothing alleviates the pain

Absent cremasteric reflex on the right

No past trauma to groin area

No transillumination of the scrotum

Sexually active male

No palpable mass to right scrotum

No penile discharge, inguinal lymphadenopathy, or hernias

Physical discomfort

No palpable mass to right scrotum

Swollen, tender, erythematous right scrotum

Doppler ultrasonography

Ultrasonography for blood flow and scrotal imaging (Cash et al., 2020). If the diagnosis is uncertain and the pain is less severe, this test can confirm testicular torsion. If testicular torsion is present, intratesticular blood flow is diminished or absent, resulting in lower echogenicity relative to asymptomatic testis (Kaplan, 2018).

History and physical

A history and physical examination suggestive of testicular torsion may necessitate rapid surgical exploration without further diagnostic tests (Kaplan, 2021). In this case, only a medical history and physical examination are necessary to confirm the diagnosis.

Urinalysis

Normal in 90% of testicular torsion cases (Cash et al., 2020). If abnormal, it indicates another diagnosis (such as epididymitis or orchitis) (Kaplan, 2018).

Urine Culture

To rule out urinary tract infection and epididymitis as the cause of the scrotal symptoms (Schick & Sternard, 2020).

Surgical Intervention

Urgent referral to urologist or emergency room. Torsion of the testis is a urologic emergency necessitating surgery (Cash et al., 2020). Testicular necrosis may develop if symptoms linger longer than four to six hours (Domino et al., 2020).

Monitoring

Patients should be monitored for postoperative complications, including infection, and delayed complications such as testicular atrophy and infertility (Kaplan, 2018).

Follow-Up

Follow- up with urologist as recommended post procedure (Cash et al., 2020)