Manivel Vijay, Mirmiran Behzad
Emergency Department, Nepean Hospital, New South Wales, Australia; Blacktown and Mt. Druitt Hospitals, New South Wales, Australia; Sydney Adventist Hospital, New South Wales, Australia.
Emergency Department, Nepean Hospital, New South Wales, Australia.
J Emerg Med. 2020 Jan;58(1):85-92. doi: 10.1016/j.jemermed.2019.09.020. Epub 2019 Oct 22.
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).
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.
阴囊超声有助于快速诊断睾丸完全扭转，并评估急性阴囊疼痛的其他病因。早期发现睾丸扭转并进行手动或手术再灌注，对于维持睾丸的存活至关重要。手动扭转复位还可通过减轻缺血立即缓解症状。由训练有素的急诊科医生（EP）进行床旁超声检查，可通过在急诊科进行超声引导下的手动扭转复位，显著缩短诊断和再灌注时间。
我们报告了两例由急诊科医生在急诊科成功进行超声引导下睾丸手动扭转复位的病例。手动扭转复位后，两名患者均接受了择期睾丸固定术，术后恢复良好。急诊科医生为何应了解此操作？：手动睾丸扭转复位是一种简单、安全且有效的操作，急诊科医生可在急诊科进行。床旁超声有助于确诊睾丸完全扭转（无血流）以及手动扭转复位后成功再灌注。我们建议对急诊科医生进行阴囊超声检查和扭转睾丸手动扭转复位的培训。我们强烈强调，睾丸手动扭转复位不能替代确定性的手术治疗措施，仅应用作再灌注的临时措施，以便有更多时间安排手术事宜，这在偏远地区可能至关重要。
