A 74-year-old man presented to the emergency department of our hospital at 4:00 a.m., with severe pain in the left hemiscrotum, radiating to hypogastric nausea, left iliac fossa and left lumbar area vomiting.
Pain appeared suddenly and progressively increased in intensity despite treatment with opioids.
He had no fever, no voiding symptoms, and no changes in intestinal rhythm.
He was diagnosed with left renoureteral crisis, being treated as such and in the absence of improvement of the clinical picture was requested evaluation at three hours by the urology service.
(a) Personal history:
The patient had a history of severe heart disease with two episodes of acute myocardial infarction and angina pectoris.
It also presents chronic obstructive pulmonary disease (with intense obstructive component) and two transient ischemic accidents.
When asked about urological history, he did not report hematuria, nor renoureteral crisis, nor had previous episodes of urinary tract infections.
(b) "physical establishment" means:
Constants were normal.
Chest examination revealed decreased ventilation in both lower fields.
The abdomen was blushing and depressible, with no signs of peritoneal irritation.
No masses, enlargement or hernias were found.
Discrete pain on percussion in the left iliac fossa bilateral negative percussion-pump.
genital discharge, penis and right test results were absolutely normal.
The left test was horizontal and ascended to the superficial inguinal orifice, and very painful to palpation.
The abolished creamy reflex.
Prehn's sign was positive.
There were no inflammatory changes in the scrotum skin.
(c) additional proof:
Routine urinary sediment was reported as normal.
We performed a preoperative study, which is normal except for right bundle branch block seen on electrocardiogram.
(d) Attitude and treatment:
After the re-exploration of the patient, the diagnostic suspicion and diagnosis were made, performing testicular exploration via posterior serum, in which we appreciated the diagnostic suspicion and the hot test in the left cord with physiological delay recovery and ischemic test.
Two days after surgery the patient was discharged.
