Deep Dive MW R19

* 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