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What is Acute onset of painful scrotal swelling in a 12 year old boy. What will you do immediately? and explain in detail?
Ans. (a) Doppler stethoscopeRef. Bailey and Love 27th Edition, Page 1500* As abdominal wall muscles contracts, cremaster also contracts, makes a rotation of the testis in vertical axis* The stimuli may be a mechanical, sexual, thermal one due to straining on stool, sport, sex, lifting heavy weight, etc.* Two factors which decide the damage of testis are extent of twist and duration of the episode.* Twists of 720 degree causes more ischemia than twists of 360 degree.* If the untwist is done in "6 Hours "time - 100% chance for the test is to be viable, if done at 24 hours only 20% chance for the testis to survive.* IOC is Doppler USG, But False positive results are can be seen. If there is a doubt- Explore.* Exploration must be done by transverse scrotal incision. Three nonabsorbable suture must be made to fix it to the scrotal raphe.