In A&E with 17 year old and worried we are being fobbed off

[NinnyNewName]

Displaying the symptoms of testicular torsion. Started Thursday. Pain level a 6/7. This morning was doubled over in bathroom (I was in room next door and heard him). Pain a 9.

Been rushed through A&E which we are grateful for.

But doctor said it's not that because 1) the pain isn't constant and 2) no nausea and vomitting and 3) they feel normal.

I'm not happy. From what I've read the pain comes and goes, there's not always sickness and they can feel normal.

Sometimes surgery is required to diagnose.

The stakes feel very high. If it goes on too long there's a risk to the testicles.

DH dropped us and is on the way.

But I am not happy anyone for any experience/what should I do?

They won't diagnose from patient-reported history, they diagnose from presentation when they see 'em. Is he in pain right now?

Say you need a diagnosis - if it's not that what is it?

Possibly varicose veins in the balls.

I've just read a report on how to manage it by the NHS. It says:

Nausea and vomitting not always present
Pain comes and goes
Diagnosis should never be based on examination alone.

The stakes are v v high if it is that and they send us home re saving the testicle(s).

The pain has just started again. Not as severely. They have given him pain relief.

I have spoken to the nurse. They have called the urologist and a surgeon.

Ask for a second opinion.

I hope he feels much better soon.

My son had a torsion aged 19, 10 years ago. He told me in the morning he’d got Intermittent pain, but insisted on going into uni. Went to A&E later with his dad, due to pain, no nausea or vomiting.
Consultant wasn’t sure, and sent him home, with appt for a scan the following day, torsion confirmed and he had testicle removed the following day.
He dealt with it really well, had a “falsie” put in a couple of months later.

Hope your son is ok.

Could be an infection which can cause excruciating pain. I certainly hope its something easily fixed and that you can be reassured soon. Very scary for you all.x

I agree ask to be re-assessed, good luck

Insist on a scan before he's discharged

My brother had this, aged about 15 (many years ago) - severe and escalating but intermittent pain, no nausea or vomiting from memory. Taken to hospital by ambulance on the 3rd day when he was unable to walk and had a fever, exploratory surgery revealed neither obvious infection nor torsion.

He recovered shortly afterwards, all very odd. Unless of course my mother didn't tell me everything!

Good luck, I hope he gets sorted soon - it's an awful pain for them, I remember my brother's dreadfully ashen face. He was so poorly.

@NinnyNewName

The pain has just started again. Not as severely. They have given him pain relief.

I have spoken to the nurse. They have called the urologist and a surgeon.

That's good to know re calling in the urologist. You may have initially been suffering from "weekend staffing syndrome" whereby you see a generalist registrar because all the specialists are off enjoying their weekend (happened to me this time last year with a gall bladder infection, which mean that by the Monday it was too inflamed to operate safely...)

Fingers crossed that you will get a more useful response from the urologist.

Have they checked for blue dot? It is an indicator of testicular appendage torsion. It can present as a more longer running come and go pain - is still very painful. It resolves itself.

Surgeons will look for a teltale blue on testicles. He should be examined by surgical consultant regardless.

Urology surgeons.

Regardless, a torsion is a medical emergency so needs to be 100% ruled out.

Thanks all. General surgeon called on call urology surgeon. Plan is to come back Monday to see urology team and have scan (which from the NHS Commissioning article can also be unreliable and shouldn't be used to rule it out).

If any more episodes before then come back in.

Not 100 pc happy but better than it was.

I think it's intermittent and therefore it could go either way

My DS had to have explorative surgery because of testicular pain last year, it wasn’t a torsion thankfully but they wouldn’t have known for sure unless they had done the surgery. I’d ask for a second opinion.

It sounds to me like a varicocele, or as the OP puts it varicose veins in the balls. I had this at about the same age initially is was treated by using underpants which gave lots of support and when severe a Suspensory Bandage. About ten years later I had a Hernia operation and the dealt with the varicocele at the same time. It's not really dangerous but can temporarily reduce fertility until dealt with by a straightforward operation.

@NinnyNewName
Hope your son is ok
My DS was writhing in agony on the floor at a similar age, crying in pain- hospital could find nothing obviously wrong, but the pain was so severe DS couldn’t walk upright
Poor lads eh x

If it comes and goes it could well be a testicular appendage torsion - did anyone talk about looking for a blue dot? Pain will last about a week if it is.

No-one talked about a blue dot.

I'll look at varicocele.

He does sleep naked and the pain has been in the mornings within a couple of hours of getting up.

If it happens again we'll be straight back to A&E. The second doctor was better, but let slip about not wanting surgery especially on a weekend.

@Slingsanderrors at what happened to your son. He sounds like a such a brave chap. Was the pain very spread out at first?

DS came in the kitchen Thursday morning, where I was, and literally dropped to his knees in pain. Me, knowing not very much about bollocks just thought he'd pulled sth (he'd not long been up). Went away after 5 or so minutes.

This morning I was in DS2's room and DS1 was in the bathroom next door. I heard him bang something and heard him deep breathing. It was worse this morning. 9 out of 10 on the pains scale.

I imagine the nerves are in a state of flux. Apparently if they stay in the twisted state surgery needs to be done ASAP: if it's more than 24 hours there's only a 10% chance of keeping the testicle.

My worry is that the pain today was much worse than the pain on Thursday. Which to me says those nerves are trying hard to twist.

Also, as @Updownin says, we need a diagnosis (not convinced it's varicocele because from what I've read it very rarely causes this level of pain).

So I'm very worried and won't be leaving him alone before Monday's appointment.

What I don't know is, can they do something preventative, to get it out of the state of flux, so that it doesn't actually twist for good and need surgery. And what are the chances of it going away.

If it is a torsion, and they get to it in time, I believe there is a procedure to attach the testicle to the wall of the scrotum so that it can no longer twist.

Good luck, OP, you must be (understandably) worried sick.

Oh gosh. I think it’s 8 hours and after that there is a possibility of the testicle dying.
My son had pain (he was 9 at the time I think). Took him to A&E at 5:30 and he was in surgery by 8:30. No messing about. They said the only way to know for sure is to do surgery. Turns out it wasn’t and all was ok.

I really wouldn’t leave the hospital without getting this done. If they wait until Monday and is is a torsion it will be too late to save it.

My brother was diagnosed with testicular torsion at 17. Had surgery very quickly. Two weeks later the pain returned, it was actually kidney stones.

Your poor son Lady. Was the pain constant? This seems to be the deciding factor. There is intermittent testicular torsion. They said if the pain lasts more than one hour we should go back. (DS said to me he wouldn't be able to handle that level of pain for that long bless him). My understanding is that because it's not in a constant state of torsion and it seems to be self correcting it's not so urgent. But can they do anything to prevent it going into full torsion because otherwise how are you supposed to live knowing that it could happen at any time and if/when it does you need to be in surgery within 24 hours or you might lose a bollock.

But tbh what if it happens tomorrow morning? They didn't have a urologist in today in this small city hospital so they won't have one tomorrow. I had the chance to go to that hospital or the large major trauma centre hospital: we are equidistant. I chose the former as I thought it would be less busy.

I am not happy about being home but I challenged the first doctor's diagnosis, then I spoke to a general surgeon and he examed DS and called the duty urologist at the other, big city hospital. And actually he struggled for 15 minutes to get hold of anyone and called this particular consultant urologist even though he wasn't due on shift for another couple of hours. He called him in my prescence too so I heard everything.

So I don't know what I could have done. Typically we've had private health for 20 years but DH has just changed jobs and it's not set up yet so we have no cover. (I think the NHS are fab btw).