A 16-year-old boy presents with four hours of sudden severe left scrotal pain during a football match. The testis is high-riding, horizontally lying, exquisitely tender, and the cremasteric reflex is absent on the left side. What is the correct management?

• A Scrotal Doppler ultrasound before any intervention, whatever the delay
• B Broad-spectrum antibiotics and analgesia with outpatient review
• C Immediate surgical exploration and fixation of both testes ✓
• D Manual reduction alone with elective follow-up ultrasound

Explanation

An acute scrotum with an absent cremasteric reflex and a high-riding horizontal testis is testicular torsion until proven otherwise, and clinical suspicion mandates immediate scrotal exploration without waiting for imaging. Viability falls sharply beyond six hours of ischaemia, so delay for Doppler risks losing the testis. At operation the affected testis is detorted and fixed, and the contralateral testis is fixed as well because the bell clapper deformity is usually bilateral. Manual reduction is only a temporising manoeuvre when theatre access is delayed.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.