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Necrotising soft tissue infection — RCPSC EM MCQ

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HardInfectious disease emergenciesNecrotising soft tissue infectionRCPSC EM

A 15-year-old has sudden unilateral testicular pain, vomiting, high-riding transverse testis and absent cremasteric reflex for two hours. What is the most appropriate next step?

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Correct answer: A — Call urology immediately for urgent exploration while preparing analgesia

The best answer is “Call urology immediately for urgent exploration while preparing analgesia”. This is testicular torsion until proved otherwise. Urology consultation and operative fixation must not be delayed for imaging when clinical suspicion is high; manual detorsion may be attempted as a bridge but never replaces urgent fixation. Delay threatens testicular viability, which declines markedly after several hours of ischaemia.

Reference: Emergency Care BC: Testicular Torsion—Diagnosis and Treatment: https://emergencycarebc.ca/clinical_resource/clinical-summary/testicular-torsion-diagnosis-and-treatment/