Hi. I'm Dr. Clark and I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.
Was his pain into his scrotum and testicle area and was it more on one side than the other?
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The pain was on his left side. The pain was on his upper thigh just below his groin. He also experienced pain in his scrotum area.
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I suggest you take him in to see his pediatrician as he might have had torsion of his testicle, which is a twisting of the testicle on its blood supply, which is very painful.
This condition, if it lasts more that 12 hours, can permanently damage his testicle and from the story you present here that is a likely possibility. Here is more information about this:
He is not experiencing pain today.
He may have had a temporary torsion and it untwisted but that means he is at high risk for this to occur again at any time and then it becomes a surgical emergency rather than something that can easily be prevented with a minor outpatient surgery procedure.
I'd take him in and his doctor will likely have a urologist see him to evaluate this. In the meantime if this happens again you should take him to the ER immediately so a sonogram can be done and then a quick repair if needed to save the function of his testicle for the future.
Sorry to lay this scary stuff on you but it can be very serious
His pediatrician will likely tell you the same thing and if not then you should mention testicular torsion as it is a distinct possibility with the history you presented here.
The pain was more in the leg and groin vs testicles. No elevation of his testicles either---everything looked normal. The acute pain was on his upper leg just below his groin and shot into his testicles. He only mentioned the pain there after we asked him if it also hurt there.
I will definitely call the doc and get him him asap but the location of the pain and the normal appearance of his testicles have me thinking his "business" will check out fine.
It might be a hernia then but any time there is pain in this area it raises a number of possibilities, some of which can be dangerous: hernia, torsion, even a kidney stone can cause pain like his. I doubt just constipation would have done this but it would not hurt to have him checked out by his doctor and you should raise the possibility of a torsion to his doctor.
When you call the doc tell them you are concerned about torsion so they will get him in today.
Wouldn't he still be experiencing pain today if this was a more serious condition? I am pretty sure our dr will get him in today without me mentioning any conditions.
Wouldn't he still be experiencing pain today if this was on the serious side?
No, as torsion can be intermittent, as can a hernia or pain from a stone.
That is the issue with torsion in that if it happened once it will happen again and the next time it may not de-rotate spontaneously and he could lose his testicle. A stone will cause blood in the urine, but only detectable with a urine test and a hernia can be felt with the proper exam by his doctor.
Will they be able to determine whether he had torsion through examination?
Not really but knowing that it is not a stone and there is no hernia eliminates them and makes torsion a real possibility and a referral to a urologist would be in order. It is better to be safe than sorry as there is only an 8-12 hour window for surgical correction the next time it happens.
Some kids have what is called a "bell-clapper testicle" where the testicle does not have the normal attachment to the base of the scrotum thus allowing it to twist. Repair is simple with a small incision in the scrotum and a couple of stitches attaching the testicle to the scrotum and then it can't happen again.
Many of these kids have the repair based solely on the history as the urologist are not willing to take a chance on losing the testicle if you can't get to the hospital in time due to travel and distance issues.
thanks. got him in to the dr this am.
Please let me know if you have any questions and good luck.
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No urologist recommended. Primarily because the pain was / is in the upper leg and groin. No swelling, redness or any indication that there was a trauma. Thinks it is nothing more than a bad muscle pull near/in his groin.
and the pain was not in his testicle and was never sore to the touch. He did not think that would cause a limp or for the pain to be so acute primarily in the groin/ upper leg as described. He was more concerned with a potential hernia or a hip problem although a complete exam was given of his testes. He says that it would have hurt to the touch there---not acute groin pain. The groin and leg pain would have been secondary---not the other way around.
Great but I'd keep an eye on him and if the acute pain recurs have him examined then. The reason I insisted he be seen was out of concern for it being a torsion and by the way, if it were an intermittent torsion there would be no swelling as the testicle de-rotated and the blood supply was restored. Those are the trickiest ones as the history is all you have to go on to decide if it is worth investigating further. A sonogram or testicular scan at the time of the acute pain is the only real proof that torsion is going on and surgery indicated.
I've seen kids operated on with the same or less symptoms so just watch to see if it happens again.
Please let me know if you have any further questions.
We were told to keep an eye on him and we have a follow up in a week. The disconnect I think is that my doc said that his testicles would hurt during the pain episode. Painful to the touch, etc. While he was experiencing pain in his private parts the acute pain was always in the groin. He still has difficulty walking and doing stairs but better. He decided that sending us down a path to a urologist was premature at this point.
Had he had scrotal pain as the primary symptom there may have been a different direction taken.
It is very painful but the pain is the entire scrotum, groin, leg and lower abdomen, often accompanied by vomiting due to the severe pain. Swelling occurs fairly quickly but depends on whether the testicle derotates right away. I agree that torsion is not at the top of the list but I've seen lots of kids who were suspicious for intermittent torsion and sent them to the urologist anyway. Sometimes they operate and that is when they find the "bell clapper" thing and once fixed it never happens again.
A hernia is also going to cause pain and swelling from the lower abdomen down into the scrotum on one side, may not cause much pain though, and once reduced does NOT continue to cause soreness, so that's not high on my list for your son.
A hip sprain is also a possibility and with ibuprofen and rest will go away in a day or two. I see lots of kids, usually younger though, with that problem. I am completely in pediatric urgent care so only see sick and injured kids now but over my 34 years have seen lots of kids like your son with hard to explain symptoms that finally become obvious as time goes by, especially when examined while in pain.