You are a general surgeon in a rural community hospital with surgical capabilities. The emergency physician calls you at 1:00 am and says that a 12-year-old boy has come in with sudden-onset right-sided scrotal pain, which started at 8:00 pm. The child and parents deny trauma, haematuria, or dysuria. Physical examination shows generalized tenderness on palpation of the right scrotum with a high-riding testicle; it is difficult to palpate the contours of the testicle. Although there is an ultrasound machine, the radiology technician is not in house and needs about 30 minutes to come in and set up the machine. What is the next step?Question 12Select one:a.Doppler ultrasound to diagnosis testicular torsion prior to interventionb.Surgical detorsion of the right testicle, orchiopexy of the left testicle, and orchiopexy of the right testicle if viablec.Transfer of the patient to the nearest hospital with a urologist on calld.Right orchiectomye.Surgical detorsion of the right testicle and orchiopexy of the right testicle if viable
Question
You are a general surgeon in a rural community hospital with surgical capabilities. The emergency physician calls you at 1:00 am and says that a 12-year-old boy has come in with sudden-onset right-sided scrotal pain, which started at 8:00 pm. The child and parents deny trauma, haematuria, or dysuria. Physical examination shows generalized tenderness on palpation of the right scrotum with a high-riding testicle; it is difficult to palpate the contours of the testicle. Although there is an ultrasound machine, the radiology technician is not in house and needs about 30 minutes to come in and set up the machine. What is the next step?Question 12Select one:a.Doppler ultrasound to diagnosis testicular torsion prior to interventionb.Surgical detorsion of the right testicle, orchiopexy of the left testicle, and orchiopexy of the right testicle if viablec.Transfer of the patient to the nearest hospital with a urologist on calld.Right orchiectomye.Surgical detorsion of the right testicle and orchiopexy of the right testicle if viable
Solution
The best next step in this scenario would be option B: Surgical detorsion of the right testicle, orchiopexy of the left testicle, and orchiopexy of the right testicle if viable.
This is because the patient's symptoms are highly suggestive of testicular torsion, a urological emergency that requires immediate surgical intervention to prevent loss of the testicle. The high-riding testicle and sudden onset of pain are classic signs of this condition.
While a Doppler ultrasound (option A) can confirm the diagnosis, it should not delay surgical intervention, especially given the time it would take for the technician to arrive and set up the machine.
Transfer to another hospital (option C) would also delay potentially life-saving treatment.
Option D, right orchiectomy, is a last resort if the testicle is not viable after detorsion.
Option E, surgical detorsion of the right testicle and orchiopexy of the right testicle if viable, does not include securing the left testicle. This is typically done in these cases to prevent torsion occurring in the future.
Similar Questions
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The two testes are kept outside the body in the scrotum for what reason?
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