17-Year-old male admitted with history of severe pain in left testicular region associated with vomiting at 4am in morning on 15.2.2018. He was consulted at premier hospital in Jaipur and investigation was done, they found that Hb-9.0, TLC-6400, platelet-271000, creatinine-0.58, USG KUB shows no significant abnormality. Pain Killer were given and sent back home. His pain persisted and was consulted in RBH OPD at 9.30am on same day and was admitted.
On general examination patient was conscious but in agony of pain in scrotal region. On local examination there was swelling and redness in scrotal region more marked on left side.
Provisional diagnosis was torsion of left testis and patient was taken to OT. Scrotal exploration. There were two twists in cord of left testis. Testis was dark in color with no blood on puncture. Testis was de-rotated and kept in warm saline for 10 minutes. Color changed from dark to mottled pink. Bilateral testicular fixation was done. Post-operative period was uneventful. Patient discharged in stable condition on antibiotics, anti-inflammatory and other supportive treatment.
Follow up Doppler study of testis was done there was equal and good flow in both testis.
Points to be learnt: acute scrotum is an emergency in teenagers and torsion of testis should be provisional diagnosis until proved otherwise. The golden hours to save testis is 6 hours from the onset of pain.