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Testicular torsion — RACP Paediatrics MCQ

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EasyEmergencyTesticular torsionRACP Paediatrics

A 14-year-old is woken from sleep by sudden onset severe left testicular pain with nausea and vomiting. On examination the left testis is swollen, high-riding, and horizontal. There is an absent cremasteric reflex. What is the most likely diagnosis and what is the time-critical intervention?

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Correct answer: C — Testicular torsion

Sudden onset severe testicular pain with a high-riding, horizontal testis and absent cremasteric reflex is testicular torsion until proven otherwise. This is a surgical emergency. The testis must be explored and detorted within 6 hours for >90% salvage rate. Ultrasound should NOT delay surgical exploration if clinical suspicion is high.

Reference: RCH Melbourne – 2023 – Acute Scrotal Pain CPG; RACP Paediatric Curriculum – Emergency