An adolescent male presents with sudden unilateral scrotal pain, nausea, and vomiting; elevation of the testis worsens pain (negative Phren's sign). What is the correct action?

An adolescent male presents with sudden unilateral scrotal pain, nausea, and vomiting; elevation of the testis worsens pain (negative Phren's sign). What is the correct action?

• A. Administer IM ceftriaxone and prescribe doxycycline twice daily for 10 days.
• B. Encourage bed rest, scrotal support, and ice packs to the scrotum as tolerated.
• C. Prescribe NSAIDs, limited activities, and warm compresses to the scrotum.
• D. Refer the adolescent immediately to a pediatric urologist or surgeon.

Answer: (D)

Acute scrotal pain with a negative Prehn sign points to testicular torsion, a time-sensitive emergency where the blood supply to the testis is abruptly cut off. Salvage of the testicle depends on rapid detorsion and fixation, so the immediate priority is urgent surgical evaluation for possible detorsion and orchiopexy. Delays for imaging or medical therapy can lead to irreversible damage and testicular loss, which is why a prompt consult with a pediatric urologist or surgeon is the best action. Antibiotics, bed rest with ice, or NSAIDs and warm compresses do not address torsion and would waste critical time. Doppler ultrasound can help if diagnosis is uncertain and there’s a short window to evaluate, but when torsion is suspected clinically, expedient surgical assessment is preferred to maximize testicular salvage.

Acute scrotal pain with a negative Prehn sign points to testicular torsion, a time-sensitive emergency where the blood supply to the testis is abruptly cut off. Salvage of the testicle depends on rapid detorsion and fixation, so the immediate priority is urgent surgical evaluation for possible detorsion and orchiopexy. Delays for imaging or medical therapy can lead to irreversible damage and testicular loss, which is why a prompt consult with a pediatric urologist or surgeon is the best action.

Antibiotics, bed rest with ice, or NSAIDs and warm compresses do not address torsion and would waste critical time. Doppler ultrasound can help if diagnosis is uncertain and there’s a short window to evaluate, but when torsion is suspected clinically, expedient surgical assessment is preferred to maximize testicular salvage.