ERRORS IN THE DIAGNOSTICS OF TESTICLE TORSION IN CHILDREN



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Introduction. Testicular torsion is an emergency condition requiring emergency medical care. Polymorphism of symptoms in testicular torsion makes diagnostics not easy and leads to late treatment what can results in irreversible damages to the testicle. Early diagnostics is a key point to organ preservation. Material and methods. The authors describe two clinical cases of testicular torsion in adolescents with errors in diagnostics. Clinical, laboratory findings and instrumental examination (MRI, ultrasound) were used for diagnostics. Results. A diagnostic error resulted in orchectomy which was made to one patient. In the other patient - despite a diagnostic error- testiclular detorsion and urgent surgical intervention resulted in patient’s complete recovery. Discussion. These examples illustrate how important is to carefully study the patient’s case-history - onset and nature of pain, associated vegetative symptoms - nausea and vomiting - which are not characteristic for other acute testicular diseases. Conventional tactics of urgent surgical intervention for all acute testicular diseases in children does not insure against diagnostic errors in case of testicular torsion with atypical symptoms. Ultrasound examination is of irreplaceable value, but one cannot be guided only by its findings in excluding testicular torsion. Conclusion. Any of the symptoms of testicular torsion - whether it is acute onset or severe pain, or a combination with vomiting, or severe pain on palpation, or ultrasound findings - is a reason to suspect testicular torsion and, it is an absolute indication for urgent surgery. The protocol for diagnostics and treatment of acute testicular diseases developed by us includes these diagnostic peculiarities and allows to choose an effective treatment modality.

作者简介

M. Grigorieva

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) of Moscow Healthcare Department of the Ministry of Healthcare of the Russian Federation; National Medical Research Center of Children›s Health (NCZD) of Moscow Healthcare Department of the Ministry of Healthcare of the Russian Federation

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Email: marina.1273@yandex.ru
ORCID iD: 0000-0002-2820-043X
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O. Sarukhanyan

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) of Moscow Healthcare Department of the Ministry of Healthcare of the Russian Federation; National Medical Research Center of Children›s Health (NCZD) of Moscow Healthcare Department of the Ministry of Healthcare of the Russian Federation

Email: noemail@neicon.ru
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E. Gasanova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) of Moscow Healthcare Department of the Ministry of Healthcare of the Russian Federation

Email: noemail@neicon.ru
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N. Teleshov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) of Moscow Healthcare Department of the Ministry of Healthcare of the Russian Federation

Email: noemail@neicon.ru
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I. Batunina

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) of Moscow Healthcare Department of the Ministry of Healthcare of the Russian Federation

Email: noemail@neicon.ru
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参考

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  2. Gatti J.M., Patrick Murphy J. Current management of the acute scrotum. Semin Pediatr Surg. 2007;16: 58-63
  3. Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. Urology. 1994;44:114-6.
  4. Perron CE. Pain -scrotal. In: Textbook of Pediatric Emergency Medicine, I. Fleisher, S. Ludwig (Hrsg.), Lippincott Williams & Wilkins and Wolters Kluwer, 6. Aufl., Philadelphia 2006, Kap. 51, S. 474-483.
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  6. Anjum N. Bandarkar, Anna R. Blask. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 2018; 48(5): 735-44. Published online 2018 Feb 21. doi: 10.1007/s00247-018-4093-0 PMCID: PMC5895684
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  9. Григорьева М.В., Саруханян О. О., Карасева О.В. Локальный протокол оказания экстренной помощи детям с острыми заболеваниями яичка. Сборник тезисов Научно-практической конференции СЗФО с международным участием «Актуальные проблемы детской хирургии», посвященный 50-летию детской хирургии Республики Коми. Сыктывкар, 16-19 мая 2017 года.
  10. Daniel DaJusta, Candace F. Granberg, Carlos Villanueva, Linda A. Baker. Contemporary Review of Testicular Torsion: New Concepts, Emerging Technologies and Potential Therapeutics. J. Pediatr Urol. 2013 Dec; 9(6): 10.1016 PMCID: PMC3566290
  11. Gatti J.M., Patrick Murphy J. Current management of the acute scrotum. Semin Pediatr Surg. 2007; 16: 58-63
  12. Caesar R.E., Kaplan G.W. Incidence of the bell-clapper deformity in an autopsy series. Urology. 1994; 44: 114-6.
  13. Perron C.E. Pain - scrotal. In: Textbook of Pediatric Emergency Medicine, I. Fleisher, S. Ludwig (Hrsg.), Lippincott Williams & Wilkins and Wolters Kluwer, 6. Aufl., Philadelphia 2006, Kap. 51, S. 474-83.
  14. Anjum N. Bandarkar, Anna R. Blask. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 2018; 48(5): 735-44. Published online 2018 Feb 21. doi: 10.1007/s00247-018-4093-0 PMCID: PMC5895684

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