TESTICULAR TORSION CASE STUDY

TESTICULAR TORSION CASE STUDY

Testicular Torsion ICD-10 CODE N44.0

Testicular torsion is the twisting of the spermatic cord, which leads to ischemia in the testicles. It should be considered an emergency due to its dire consequences if untreated or late intervention. Symptoms include sudden and severe abdominal pain in the scrotum, swelling, nausea, vomiting, and abdominal pain. It commonly affects young males, mostly in adolescence. However, it is not limited to affecting another age bracket (Keays & Rosenberg, 2019). The pathophysiology of testicular torsion begins when a testicle twists around the spermatic cord, which cuts off the venous blood flow, resulting in venous congestion and ischemia. Consequently, the testicles become tender, swollen, and at times erythematous. Further twisting of the testicle cuts off the arterial blood supply, leading to testicular necrosis (Schick & Sternard, 2020).

In Andrew’s case, a diagnosis of testicular torsion is most likely to be made. This is justified by the clinical presentation and the physical examination results. The sudden onset of pain in the groin region that radiates to the scrotum together with vomiting suggests a vascular emergency. The physical examination results showing erythematous, swollen, and tenderness of the right testicle align with the expected findings of the testicular torsion. Also, the negative Prehn sign, absent cremasteric reflex, and absent trans illumination further support the diagnosis of testicular torsion. All these findings are consistent with the signs and symptoms of testicular torsion; this, therefore, necessitates urgent evaluation and intervention to mitigate further complications like testicular ischemia and necrosis (Schick & Sternard, 2020).

Differential Diagnosis #1

Torsion of the Testicular Appendages ICD-10 CODE N44.03

Rationale: Torsion of the testicular appendages, while a common misdiagnosis for testicular torsion, is not as serious. Similar to testicular torsion, it can lead to swelling and pain but differs in several key aspects. Unlike testicular torsion, torsion of the testicular appendages often presents with a palpable blue nodule and typically involves less severe pain. In Andrew’s case, the absence of localized pain at the upper poles of the testis makes appendage torsion less likely. Unlike testicular torsion, which necessitates immediate surgical intervention to prevent complications, torsion of the testicular appendages typically resolves on its own within two weeks without the need for surgery (Schick & Sternard, 2020).

Differential Diagnosis #2

Epididymitis ICD-10 CODE N45.1

Rationale: Secondly, epididymitis, a condition characterized by the inflammation of the epididymis at the back of the testicles, may be considered a differential diagnosis in this scenario. Among its clinical manifestations are testicular swelling and pain, which are in line with the presentation of testicular torsion. However, other signs present in epididymitis are urethral discharge, a burning sensation during micturition, and other signs of infection like fever. These signs are absent in Andrews’ case; therefore, epididymitis is rejected in this diagnosis. Additionally, the absence of cremasteric reflex, prehn sign, and lack of systemic signs of infection make epididymitis unlikely in Andrew’s case. The primary intervention for epididymitis is the use of antibiotics with pain management (Schick & Sternard, 2020).

Diagnostic Techniques

To evaluate the presence of testicular torsion, the TWIST (Testicular Workup for Ischemia and Suspected Torsion) scoring system is used where the tool is used to assess and score the severity of torsion symptoms. For instance, hard testes-2, swelling-2, nausea/vomiting-1, absent cremasteric reflex-1, and high riding testis-1. Higher scores in the TWIST test suggest a high probability of having a testicular torsion, and these patients should be taken for surgery without an ultrasound (Keays & Rosenberg, 2019). Also, physical examination| Color flow Doppler| Radionuclide testing| testicular ultrasonography| scrotal scintigraphy are needed; these tests involve the use of a radioisotope to visualize the blood flow to the testes (Aihole, 2022).

Treatment, Education, and Follow-Up Testicular Torsion ICD-10 CODE N44.0

Based on the clinical practice guidelines for the management of testicular torsion, the recommended treatment plan includes:

1. Inform the patient about all possible prognoses and obtain informed consent pre-operatively.
2. Observe all the surgical procedure guidelines for the patient; nill per oral status for at least 3 hours before anesthesia | proper patient identification|obtaining samples for labs| pre-loading fluids and pre-medicatios|instrument preparation/sterilization.
3. The surgical exploration of the scrotum is the most reliable approach to managing testicular torsion; a decision concerning orchiectomy is made intraoperatively to remove the necrotized or gangrenous testes (Prendergast et al., 2022). The aims are to restore blood flow to the testes and prevent complications such as necrotizing or gangrene. The sooner the intervention is implemented after diagnosis, the higher the chances of salvage success. For instance, the salvage success of a surgery done within 6-8 hours is 100%. Pain management is also a priority for treating testicular torsion (Prendergast et al., 2022). Lastly, Prendergast et al. (2022) recommend reassessing the patient to establish the effectiveness of the approach.
4. Regular postoperative surgical follow-ups to ensure the desired therapeutic outcomes. Secondly, advise the patient to wear scrotal support and an ice pack until pain is relieved. Also, teach the patient about danger signs, such as bleeding or worsening pain.
   

References

Aihole, J. S. (2022). Testicular torsion; clinical diagnosis or imaging diagnosis? Radiology Case Reports, 17(8), 2665–2667. https://doi.org/10.1016/j.radcr.2022.05.010

Hyun, G. S. (2018). Testicular torsion. Reviews in Urology, 20(2), 104–106. https://doi.org/10.3909/riu0800

Keays, M., & Rosenberg, H. (2019). Testicular torsion. Canadian Medical Association Journal, 191(28), E792–E792. https://doi.org/10.1503/cmaj.190158

Prendergast, Collins, P., Cronin, J., Melody, L., & Mcguire, M. (2022). IAEM Clinical Guideline Testicular Torsion. https://iaem.ie/wp-content/uploads/2022/08/Clinical-Guideline-Testicular-Torsion-in-Adults-and-Peadiatrics.pdf

Schick, M. A., & Sternard, B. T. (2020). Testicular torsion. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448199/

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  TESTICULAR TORSION CASE STUDY

• Identification of the main diagnosis with supporting rationale
• Identification of at least two additional differential diagnoses with a brief rationale for why these were ruled out.
• Diagnostic plan with supporting rationale or references.
• A specific treatment plan supported by recent clinical guidelines.