This case involves a thirty-four-year-old male who presented to the emergency room with sudden onset, left-sided groin pain. The pain was constant and described to be sharp in character, but it did not radiate anywhere. The ER worked the patient up for possible kidney stones, but they were ruled out with a CT of the abdomen and pelvis. This was the only imaging study performed during the ER visit as the patient was discharged with pain medication, antibiotics, and given the diagnosis of a pain of unknown etiology. A primary care doctor saw the patient for a follow-up and it was at this point a possible diagnosis of testicular torsion was entertained. An ultrasound was performed that day, which showed findings compatible with severely decreased blood flow to the left testicle. The patient was scheduled for a left orchiectomy and right testicular fixation, which was considered to be non-emergent in nature due to the delayed diagnosis.
Question(s) For Expert Witness
- 1. What is the standard of care in diagnosing and treating testicular torsion?
Expert Witness Response E-000320
Testicular torsion is a clinical diagnosis. If the history and physical examination strongly suggest testicular torsion, the patient should go directly to surgery. When a low suspicion of testicular torsion exists, color Doppler and power Doppler ultrasonography can be used to demonstrate arterial blood flow to the testicle, while providing information about scrotal anatomy and other testicular disorders. Surgical detorsion is the definitive treatment for testicular torsion. Manual detorsion of the torsed testis may be attempted but is usually difficult because of acute pain during manipulation. Nonoperative detorsion is not a substitute for surgical exploration. If manual detorsion is successful (ie, confirmed by color Doppler sonogram in a patient with complete resolution of symptoms), the patient should undergo definitive surgical fixation of the testes before leaving the hospital. Then, the operation can be performed as an urgent rather than an emergent procedure.