A 40-year-old man presents with sudden-onset severe scrotal pain and a horizontal ('bell clapper') lie of the right testis. The right testis is swollen and elevated. Doppler ultrasound shows absent right testicular blood flow. What is the management?

• A IV antibiotics for epididymo-orchitis and urology follow-up in 48 hours
• B Manual de-torsion under analgesia followed by elective orchidopexy
• C Doppler re-scan in 2 hours for confirmation
• D Emergency surgical exploration, de-torsion, and bilateral orchidopexy within 6 hours of onset ✓

Explanation

Testicular torsion is a urological emergency; the viable testis rate is >90% if de-torsioned within 6 hours, but falls to <10% after 24 hours. Emergency scrotal exploration, de-torsion of the affected testis, and bilateral orchidopexy (to prevent contralateral torsion — the bell-clapper deformity is usually bilateral) must not be delayed for further imaging when clinical suspicion is high.

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

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Written and medically reviewed by the StethoPrep medical team.