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  • 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