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FOCUSED SHIFT VIEW

Scrotal Pain & Swelling

Torsion until proven otherwise — imaging must not delay the OR.

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Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Torsion until proven otherwise — high-riding transverse testis and absent cremasteric reflex go to the OR.
  2. Do not delay exploration for Doppler when suspicion is high.
  3. Salvage is highest within ~6 h, but operate on suspicion even later.

2 · Escalate now if

  • Sudden severe testicular pain with vomiting
  • High-riding or transverse testis
  • Absent cremasteric reflex
  • Perineal pain with crepitus or sepsis (Fournier)
  • Irreducible groin mass
  • Scrotal trauma with persistent pain (rupture)

3 · Immediate workup

  • Immediate urology consult when torsion is suspected — imaging must not delay the OR
  • POCUS Doppler: flow absence; whirlpool sign of the cord

4 · Don’t miss

  • Testicular torsion
    Sudden pain, high-riding transverse testis, absent cremasteric reflex — urology/OR immediately; US must not delay exploration when suspicion is high.
  • Fournier gangrene
    Perineal pain, crepitus, sepsis, diabetes — broad antibiotics + debridement.
  • Incarcerated / strangulated inguinal hernia
    Irreducible tender groin mass with obstruction signs — surgery.
  • Traumatic rupture / testicular hematoma
    Scrotal trauma — US; rupture needs repair within hours.

5 · Disposition lane

Admit

Epididymo-orchitis needing IV therapy, Fournier post-debridement, monitored equivocal cases.

Emergency surgery

Testicular torsion (immediate exploration), Fournier debridement, strangulated hernia, testicular rupture.