Ultrasound-Guided Manual Testicular Detorsion in the Emergency Department

J Emerg Med. 2019 Oct 22;S0736-4679(19)30803-0. doi: 10.1016/j.jemermed.2019.09.020. Online ahead of print.

Abstract

Background: Scrotal ultrasound helps in the rapid diagnosis of complete testicular torsion and assessment of alternative causes of acute scrotal pain. Early detection of torsion of the testis and reperfusion, either manually or surgically, is paramount to preserving testicular viability. Manual detorsion also offers immediate symptom relief by alleviating ischemia. Bedside ultrasound performed by a trained emergency physician (EP) can significantly reduce the time to diagnosis and reperfusion by means of performing an ultrasound-guided manual detorsion in the emergency department (ED).

Case report: We report two cases of ultrasound-guided manual detorsion of testis that were performed successfully by EPs in the ED. After manual detorsion, both patients underwent nonemergent orchidopexy and recovered well after surgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Manual testicular detorsion is a simple, safe, and effective maneuver that can be performed in the ED by EPs. Bedside ultrasound is helpful in confirming the diagnosis of complete torsion of the testicle (no blood flow) and successful reperfusion after manual detorsion. We recommend EPs be trained to perform scrotal ultrasound and manual detorsion of a torted testicle. We strongly emphasize that manual detorsion of the testes is not a substitute for definitive surgical management and should only be used as a temporary measure for reperfusion to allow more time to organize the logistics of surgery, which can be critical in remote settings.

Keywords: POCUS; bedside ultrasound; detorsion of testis; emergency ultrasound; manual detorsion; orchidopexy; scrotal pain; scrotal ultrasound; spermatic cord torsion; testicular torsion.