Acute and sudden scrotal pain in 16 years old boy


Testicular torsion is one of the leading causes of acute testicular pain in pubertal age. Waiting too long for diagnosis and treatment might cause loss of the testis that has to be removed because of irreversible necrosis.

In the late evening, I was called by the doctor on duty in the ER department of my hospital. He told me about a 16 years old boy came for acute left scrotal pain associated with vagal symptoms (nausea and vomiting) with only partial response to painkillers. The sudden onset in a young boy let me known about a testicular torsion and when I was in the car directed to the hospital I called to alert the Operating Room.

As I arrived I found the patient severely in pain with the testis completely retracted to the upper part of the scrotum, it was untouchable and stuck in its position.

I asked for a point-of-care Ultrasound and, even if either symptoms and signs were clear enough for testicular torsion, I demonstrate the complete absence of vascular flow in the affected testicle.

In the operating room, as I incised the scrotal skin I pulled out the testicle that appeared ischemic and blue/gray in color. The spermatic cord was coiled because of the testis turned around two times. The derotation improved almost immediately its bad aspect. As it gained a normal aspect I did orchidopexy and I closed without drainage.

This young boy was discharged after 12 hours.