Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion

Abstract

Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense.Proposed premise substantiating case (s) description:Initial diagnostic hypothesis:Syndromic:Acute Scrotum Syndrome (SEA) Main Etiologic (testicular torsion)Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

Do Not Get It Twisted

“…The use of drugs such as cocaine or methamphetamines can cause testicular ischemia, mimicking Testicular Torsion (Figure 22). 36,37 These drugs can lead to vasoconstriction of the testicular vasculature and should be considered a cause of testicular ischemia in patients with recent substance abuse.…”

Decreased Blood Flow in the Testis: Is it Testicular Torsion?

“…Case studies have shown that recent use of amphetamines, such as methamphetamine and cocaine, can lead to decreased testicular blood flow secondary to vasoconstriction through alpha-1 receptor activation. [20,21] These conditions Color flow Doppler ultrasound is unable to detect blood flow when the flow rate is less than 6 cm/second. As evidenced by histopathology, the testis was viable in this patient.…”

Cocaína y escroto agudo ¿Existe alguna relación?

“…Estos hallazgos pueden sugerir cuadros clínicos de escroto agudo, debido al alto grado de isquemia en el cordón testicular, y su único tratamiento consistirá en cirugía. [5][6][7] Los pacientes con escroto agudo requieren pronta evaluación; existen múltiples diagnósticos diferenciales relacionados con esta alteración y debido a la superposición de síntomas y signos, es difícil indicar tratamiento quirúrgico. Barbosa y sus coautores reportaron la escala TWIST (por sus siglas en inglés: Testicular Workup for Ischemia and Suspected Torsion), basada en cinco parámetros clínicos: hinchazón testicular (2 puntos), testículo duro (2 puntos), ausencia de reflejo cremastérico (1 punto), náuseas-vómitos (1 punto) y testículos ascendidos (1 punto).…”