Medical Malpractice Insights: Was this testicular torsion missed or not?

Here’s a case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians, and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here.

Chuck Pilcher, MD, FACEP

Editor, Med Mal Insights


Was this testicular torsion missed or not?

Care can be sub-standard but not negligent

Facts: A 27-year-old male presents to the ED with left groin pain for the past 2 days. He had a similar episode lasting 30 minutes 3 days previously. Exam shows marked tenderness in the left inguinal region. Testicle is documented as normal size and non-tender. A radiologist is consulted and suggests a CT scan of the abdomen to rule out hernia, which shows a thickened left spermatic cord. A diagnosis of epidydimitis is made, and he is discharged. He returns 26 hours later with a swollen testicle and is diagnosed with torsion. The testicle cannot be salvaged. The patient consults an attorney who has an expert review the record.

Plaintiff: I had a twisted testicle and you missed it. Now I may not be able to have kids. You should have thought of torsion and didn’t even mention that in your documentation.

Defense: Your testicle was normal when I saw you. It wasn’t twisted when I saw you. You still have at least an 80% chance of fathering children with one testicle.

Result: Although suspicion for intermittent torsion should have been higher and EHR documentation appeared questionable, care as documented was within the standard. Causation would be difficult to prove. Damages would be minimal, likely limited to ego and cosmetic. No lawsuit was filed.


Takeaways:

  • Male groin pain should trigger a high suspicion of torsion.
  • Youth and teens may describe their pain as lower abdomen rather than testicular – and this may be more likely when the physician is female.
  • The diagnosis should be affirmatively ruled out – and documented in patients with lower abdominal or groin pain.
  • While missing the diagnosis is below the standard of care, damages are limited primarily to ego and cosmetic.
  • Salvage is likely in 90% of cases of <6 hr duration, 20-50% if duration is 12-24 hours and 0-10% if over 24 hours.

 

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