Delayed Surgical Intervention Causes Patient To Lose Testicle

This case involves a 13-year-old male who presented to the emergency department complaining of lower abdominal pain. He was assessed by a nurse practitioner and diagnosed with a viral illness. The patient was subsequently discharged. Two days later, the patient presented to the same emergency department complaining of severe abdominal pain along with testicular pain. An ultrasound showed testicular tortion, and it was decided that the patient would undergo correctional surgery immediately. Despite the operation being critical and time sensitive, the patient was not taken to the operating room until 7pm that evening — over 8 hours after the decision was made to operate. The patient suffered from testicular atrophy and required an orchiectomy to remove his right testicle the following week.

Question(s) For Expert Witness

1. Please describe your background as a nurse practitioner.

2. Have you encountered similar cases in the past?

3. Have you lectured or published on this subject?

Expert Witness Response E-033816

I am certified as both an FNP and an ANP with 35+ years in emergency nursing and advanced emergency nursing practice. I have taught an emergency medicine course in a school of nursing - BSN and MSN/APN students - for 8+ years and I continue as adjunct clinical faculty. I have presented throughout the state and country on emergency nursing topics. I currently work in internal medicine as an emergency NP per diem. I have served as a content expert for the ENP certification exam. My thoughts are that initially, it may have been difficult to distinguish a testicular torsion - more information is needed. What was the presenting complaint? What questions were asked? What did the clinical exam show? Was an exam of the genitalia performed? Any diagnostic testing at that time? However, by the next day when the patient returned and the US showed torsion, time is of great importance to detorse manually if a skilled urologist or ED provider is available. Otherwise, the patient must go to the OR ASAP. The length of time before blood supply is returned to the testicle is related to the viability of the testicle. Unfortunately, loss of a testicle due to torsion is not all that unusual for adolescents. I have encountered similar cases - not that often, most have not turned out to be a torsion.