Deep Dive MW R19

* Common during the first year of life as well as during puberty











* Presents with nausea/vomiting, abdominal pain, and/or testicular pain











* ALWAYS examine a child for signs of torsion who presents with abdominal pain (especially lower abdominal pain)











* Look for tenderness, firmness, high riding testicle or testicle with unequal lie, swelling, and the absence of a cremasteric reflex











* Consult Urology IMMEDIATELY if you have high suspicion, otherwise proceed to ultrasound











* Ultrasound is only 85% sensitive, so clinical gestalt can trump even a negative US











* Attempt manual detorsion if there will be a significant delay to surgery