A 22-year-old man presents with acute-onset left testicular pain for 4 hours. On examination there is a high-riding left testis with a horizontal lie. Cremasteric reflex is absent. What is the diagnosis and the maximum ischaemia-free window for surgical intervention?
- A Epididymo-orchitis; treat with antibiotics
- B Testicular torsion; surgical exploration within 4 hours for 100% salvage
- C Testicular torsion; surgical exploration within 6 hours for >90% salvage ✓
- D Torsion of appendix testis; conservative management
Correct answer: C. Testicular torsion; surgical exploration within 6 hours for >90% salvage
Explanation
Testicular torsion presents with acute testicular pain, high-riding testis, horizontal lie ('bell-clapper' deformity), and absent cremasteric reflex. Testicular salvage rates are: >90% if detorsed within 6 hours, 50% at 12 hours, and <10% beyond 24 hours. Surgical exploration (bilateral orchidopexy or orchiectomy if necrotic) must not be delayed for imaging in clear clinical cases. The window of 6 hours for >90% salvage is clinically critical.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.