Case Study of Testicular Torsion: Therapeutic and Legal Considerations

Authors

1 Professor, Department of Neurosurgery, Kashan University of Medical Dr. Ismail Fakharian Sciences, Shahid Dr. Beheshti Hospital

2 Assistant Professor, Nephrology and Urology Specialist, Kashan University of Medical Sciences, Shahid Dr. Beheshti Hospital

3 Professor of Health Information Management, Health Information Management Research Center, Kashan University of Medical Sciences

Abstract
An 18-year-old male presented to the emergency department with flank pain that had commenced earlier that morning. The pain was localized and non-radiating, accompanied by nausea and vomiting. The patient denied experiencing fever but reported the presence of hematuria. Notably, he had not had a bowel movement since the onset of pain and indicated a family history of nephrolithiasis, specifically in his father. Upon examination, the patient's vital signs were stable, with a blood pressure of 110/80 mmHg, a pulse rate of 86 bpm, and oxygen saturation (SpO2) at 96% on room air. The abdominal examination revealed no tenderness, distension, rigidity, or guarding; however, tenderness was noted in the right paraspinal region. An abdominal ultrasound demonstrated inflammatory changes, including a slight increase in the echogenicity of the fat in the right lower quadrant (RLQ), alongside an appendix loop measuring 6 mm in diameter, consistent with the clinical and laboratory findings. The patient subsequently underwent an appendectomy on the same day, with a diagnosis of acute appendicitis.

Keywords

No

1. Lacy A, Smith A, Koyfman A, Long B.
High Risk and Low Prevalence Diseases:
Testicular Torsion. The American Journal
of Emergency Medicine
, 2023; 66: 98-104. https://doi.org/10.1016/j.ajem.2023.01.031
2. Laher A, Ragavan S, Mehta P, Adam A. Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies. Open Access Emerg Med. 2020 Oct 12; 12: 237-246. doi: 10.2147/OAEM.S236767. PMID: 33116959; PMCID: PMC7567548.
3. Taşçı Aİ, Danacioglu YO, Çolakoğlu Y, Arıkan Y, Yalçınkaya N, Büyük Y. Testicular torsion in the medicolegal perspective: Why is the diagnosis missing? Ulus Travma Acil Cerrahi Derg. 2021 Mar; 27(2): 207-213. English. doi: 10.14744/tjtes.2020.68339. PMID: 33630295.
4. Colaco M, Heavner M, Sunaryo P, Terlecki R. Malpractice Litigation and Testicular Torsion: A Legal Database Review. J Emerg Med. 2015 Dec; 49(6): 849-54. doi: 10.1016/j.jemermed.2015.06.052. Epub 2015 Sep 26. PMID: 26409673.
5. Aquila I, Abenavoli L, Sacco MA, Ricci P. The limits of diagnosis of testicular torsion in the child: Medicolegal implications in clinical practice. Clin Case Rep. 2021 Dec 9; 9(12): e05180.
6. Lyons JM 3rd, Martinez JA, O'Leary JP. Medical malpractice matters: medical record M & Ms. J Surg Educ. 2009 Mar-Apr; 66(2): 113-7. doi: 10.1016/j.jsurg.2008 April 12.002. PMID: 19486876.