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  #1  
Old 12-06-2011
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Kids Three week old with vomiting and groin mass!

A 3-week old male is brought to the emergency room by his 17-year -old mother with a 14 hour history of inconsolable crying, vomiting and a tender mass in the right groin. Which one of the following is most likely diagnosis?
1) colic
2) acute hydrocele
3) testicular torsion
4) child abuse
5) incarcerated hernia
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  #2  
Old 12-06-2011
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3)testicular torsion
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  #3  
Old 12-06-2011
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Default Torsion

testicular torsion is the answer ,, key word >> inconsolable crying ,, in testicular torsion pain is persistent ,, in colic it's intermittent ,, in hydrocele it's unusual to cause such jeopardy to the newborn ,, in child abuse, nothing is specifically suggesting it in the case ,, in incarcinated hernia there would be associated dehydration and electrolyte imbalance making it impossible for the child to handle the energy needed for the inconsolable crying for 14 hrs unless he his breast fed on Red Bull
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  #4  
Old 12-06-2011
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In some forums ,it says Incarcerated Hernia ,but no explanation was there.
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  #5  
Old 12-06-2011
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i pick up the ans incarcerated hernia because of vomiting......... vomiting differentiate testicular torsion n hernia.
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  #6  
Old 12-06-2011
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Default Torsion causes vomiting too

Quote:
Originally Posted by qurat21 View Post
i pick up the ans incarcerated hernia because of vomiting......... vomiting differentiate testicular torsion n hernia.
Torsion is associated with vomiting too

review this :

http://emedicine.medscape.com/article/778086-overview
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  #7  
Old 12-06-2011
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Well for me, I would go with 5) Incarcerated Hernia.
I don't know.. I mean all of the answers listed could cause inconsolable crying, it's not only specific for Testicular Torsion.. and also the case is too short to rule out the other stuff..
and if we were to choose the most common cause then it is Colic for sure. but the tender mass isn't a feature of colic.

any answer for this question.
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  #8  
Old 12-06-2011
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Answer should be incarcerated hernia

From
Nelson Textbook of Pediatrics, 19th ed. 2011
Testicular torsion produces acute pain and swelling of the scrotum. On examination, the scrotum is swollen, and the testis is exquisitely tender and often difficult to examine. The cremasteric reflex nearly always is absent. The condition can be differentiated from an incarcerated hernia because swelling in the inguinal area often is absent with torsion.
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  #9  
Old 12-06-2011
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Default What if ?

Quote:
Originally Posted by bebix View Post
Answer should be incarcerated hernia

From
Nelson Textbook of Pediatrics, 19th ed. 2011
Testicular torsion produces acute pain and swelling of the scrotum. On examination, the scrotum is swollen, and the testis is exquisitely tender and often difficult to examine. The cremasteric reflex nearly always is absent. The condition can be differentiated from an incarcerated hernia because swelling in the inguinal area often is absent with torsion.
What if the testicle retracted up in the inguinal canal after torsion
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  #10  
Old 12-06-2011
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Quote:
Originally Posted by dr-ahmed View Post
What if the testicle retracted up in the inguinal canal after torsion
well, I dont think they going to ask "the what if" in the exam
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  #11  
Old 12-06-2011
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Default Just a trial

Quote:
Originally Posted by bebix View Post
well, I dont think they going to ask "the what if" in the exam
I'm not trying to manipulate the answer here ,, I'm just trying to get into a precise choice according to the best of our knowledge
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  #12  
Old 12-06-2011
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Quote:
Originally Posted by dr-ahmed View Post
I'm not trying to manipulate the answer here ,, I'm just trying to get into a precise choice according to the best of our knowledge
hahaha...I know...but...let me give you another "what if"

According to Campbell (Urology bible):

"Although intravaginal testicular torsion may occur in any young male, the peak age at occurrence is 12 to 16 years, with additional cases occurring in postpubertal males and 86% to 93% occurring after age 10...
The presentation of perinatal torsion is variable, depending on the timing of the torsion event. Suggestive clinical findings at birth include testicular induration and scrotal erythema or dark discoloration with or without edema. The infant is typically asymptomatic, and testicular tenderness may or may not be present. In a significant minority of cases, the symptoms present in the neonatal period or later, after documentation of a normal neonatal examination."

So, is pretty rare if you are a neonate
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  #13  
Old 12-06-2011
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Default UpToDate 19.3

updated: June 7, 2011

Neonatal testicular torsion, defined as torsion occurring within the first 30 days of life, is a rare occurrence.

In neonatal torsion, the tunica vaginalis is not well-fixed to the scrotal wall, and the torsion involves the entire testicle, including the tunica vaginalis investment. Neonatal torsion is a distinct entity from testicular torsion in older patients, which typically is caused by intravaginal torsion when the testis twists within its tunica vaginalis.

Prenatal torsion is detected at or within 24 hours of delivery during the initial newborn examination. The neonate does not demonstrate any clinical signs of distress.

Postnatal torsion presents with acute tenderness and swelling in a testicle that was previously noted to be normal on physical examination
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  #14  
Old 12-06-2011
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Default

Quote:
Originally Posted by bebix View Post
Answer should be incarcerated hernia

From
Nelson Textbook of Pediatrics, 19th ed. 2011
Testicular torsion produces acute pain and swelling of the scrotum. On examination, the scrotum is swollen, and the testis is exquisitely tender and often difficult to examine. The cremasteric reflex nearly always is absent. The condition can be differentiated from an incarcerated hernia because swelling in the inguinal area often is absent with torsion.
I agree with Bebix.. that was the point confusing me because testicular torsion doesnt present with mass in the groin

So after discussion.. the answer is INCARCERATED HERNIA
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