Undiagnosed torsion of the testicle

This case study demonstrates the expertise of our Clinical Negligence team who recently acted for a man suffering from a torsion of the testicle. He was misdiagnosed during three separate hospital attendances despite the GP repeatedly diagnosing the condition correctly.

The male claimant, who was in his late 20s, attended hospital by ambulance after suffering from acute pain in his lower abdomen for two hours. While in hospital he was given a rectal suppository for the intense pain (which he was asked to administer himself).

Approximately two hours later, he was reviewed by an A&E doctor who took a detailed history specifying: ‘abdominal pain, sharp, shooting, lower abdominal pain since 8 am today. Constant and reaching 10/10 intensity.’  Testicular pain was also specifically noted. The claimant asked the doctor if she needed to examine his testis.  She declined, saying it was unnecessary. Her questioning then began to focus on his sexual history and he was informed that he may have gonorrhoea. No scrotal examination took place during that admission. The doctor discussed the claimant’s case with the urology department. However, he was not seen by a urologist. It appears that the incorrect history was passed to the urology department and it was suspected that he may have appendicitis or a kidney stone. The claimant’s stomach was x-rayed and he was then discharged home with painkillers.

The following morning the claimant’s testicle had begun to swell and he immediately attended his GP. The GP diagnosed a torsion of the testicle and made an emergency referral back to the A&E department. He telephoned ahead to warn them of the claimant’s impending arrival.

When the claimant arrived at hospital for the second admission he was left in the waiting room for four hours before being seen by a doctor.

The doctor reviewed the history taken on the previous attendance and informed the claimant that she “was not sure” what the correct diagnosis was. She rang two other colleagues for their advice while the patient was present. During this consultation, the claimant asked whether an ultrasound scan could be performed to see what the cause of the swelling in his testicle was. He was informed that an ultrasound scan would not normally be done in these circumstances as they were expensive. After further persuasion, the doctor agreed to the scan. The claimant was then discharged home with a four weeks prescription for antibiotics.

The following day the claimant began to suffer from a fever and associated symptoms. These symptoms increased over the next four days and he lost his appetite. On the evening of the fourth day the claimant was violently sick.  He awoke the following morning shaking uncontrollably, with pain in his shoulders and arms. At this stage, following his recent experience in hospital, he felt that he may be making a fuss about nothing so he did not seek any medical advice. On the sixth day the claimant’s mother took him back to his GP. Again, the GP immediately diagnosed torsion of the testicle and again made an emergency referral back to A&E, telephoning ahead to request urgent action.

At hospital, the claimant sat in a waiting room for two hours before his mother asked for a doctor to review him. A doctor reviewed the claimant’s scrotum and history and advised that he should be sent home with another four weeks’ worth of antibiotics.

The claimant’s mother stepped in and asked very firmly for a second opinion. A urologist reviewed the claimant and immediately admitted him as an in-patient for emergency surgery on his scrotum.

During the operation infarction of the right testis was noted. It was also noted that the testis and epididymis were black and therefore a right orchiectomy (removal of the testis) was carried out and the left testis was fixed in place.

The claimant was devastated by the loss of his testicle and struggled to come to terms with the loss.

The trust admitted liability at an early stage enabling us to achieve a settlement of £23,000 in damages which included the cost of surgery for a testicle prosthesis implant.

Comment

Over the last two years, the clinical negligence team at Thomson Snell & Passmore has noticed an increase in the number of misdiagnosed torsions of the testicle. From our position, the crux of the problem appears to stem from the lack of direct involvement of urology specialists at an early stage. Many of the cases involve the A&E clinicians recounting the medical history (sometimes incorrectly) over the telephone to the urology departments which, in turn, is leading to the incorrect advice being given by the urologists and the correct diagnosis not being made within the crucial time window.

The above case is not typical as the patient was not in the most high risk age bracket. However, we are noting that similar misdiagnoses are being made in patients who are in the most high risk age bracket for torsions.

Read about our experience in accident & emergency cases.

James Cahan specialises in cases involving accident & emergency and torsion of the testicle. If you would like to ask James a question about a potential case involving the retention of a foreign body following surgery or you have a general query about medical negligence contact James on 01892 701289 in confidence.