A 14-year-old boy presents with sudden severe left scrotal pain of 5 hours duration, vomiting, and a high-riding, horizontally lying, exquisitely tender testis with an absent cremasteric reflex. Colour Doppler shows absent intratesticular flow. Management should be:

• A Antibiotics for epididymo-orchitis with scrotal elevation
• B Manual detorsion followed by outpatient follow-up only
• C Immediate surgical exploration regardless of imaging findings ✓
• D Repeat Doppler after 24 hours to confirm the finding

Explanation

The absent cremasteric reflex with a high-riding transverse testis is highly specific for torsion, and absent flow on Doppler confirms it. Surgical exploration must proceed immediately because salvage rates fall sharply after 6 hours and approach zero beyond 24 hours. Waiting for repeat imaging wastes ischaemic time. Manual detorsion, if attempted toward the lateral side, is only a temporising measure that still mandates subsequent bilateral orchidopexy.

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.