Dr Swasthik Jain
ABSTRACT:
Testicular Torsion is when tissues around the testicle (also known as the “testis”) are not attached well. This can cause the testes to twist around the spermatic chord. When this happens, it cuts off the blood flow to the testicle. It can cause pain and swelling, and should be treated as an emergency. This is a case of Mr XYZ aged about 25 years male who presented with the complaint of severe pain in the left scrotal region radiating to left inguinal region and Difficulty in walking due to the pain since morning on 26/6/23. Patient advised for USG scrotum with Doppler which showed the features of intermittent testicular torsion for which surgery advised by the surgeon but patient was not willing to go for it.
On 26/6/23 case was taken at Government homoeopathic medical college and hospital, Bengaluru and detailed clinical examination of scrotum was done, then patient is prescribed based on acute totality of symptoms using synthesis repertory software. Patient showed marked improvement in the pain by evening and by next day he was able to walk without any pain, swelling reduced completely by 28/6/23. Repeat USG scrotum with Doppler was done on 3/7/23 which showed complete remission of the torsion. (Reports attached with the case sheet) These results are very much encouraging and giving us the more confidence to work in the field of acute emergency cases.
INTRODUCTION:
Torsion of testis is an emergency condition, wherein the testis twists (rotates) in its axis compromising its blood supply. If not intervened and rectified within 12-24 hours, testicular gangrene may occur. It occurs in children and adolescents. Presents with sudden onset of pain in the scrotum, groin and lower abdomen, Vomiting due to pylorospasm. Tenderness, redness and oedema of the scrotal skin.
Emergency exploration of the scrotum and untwisting of the torsion testis is done. Then viability of testis is checked. Once confirmed, the testis is fixed to the scrotal sac using 2-3 interrupted nonabsorbable sutures (Prolene). If surgery is done within 12-24 hours, viability of the testis may be retained. If delayed, testis becomes gangrenous and orchidectomy is done.
CHIEF COMPLAINT WITH DURATION
Patient came with the complaint of pain in left scrotal region since morning.
DETAILS OF CHIEF COMPLAINT
| LOCATION | SENSATION | MODALITY | ACCOMPNIMENT |
| GENITO-URINARY SYSTEM:
SCROTAL REGION |
Pain and burning sensation. | < Walking & change in posture |
HISTORY OF CHIEF COMPLAINT
- Patient was apparently healthy till 26/6/23 morning then he suddenly got the complaint of pain in left side of the scrotal region which is radiating to left inguinal region.
- Pain aggravates by walking or change in posture.
- Patient couldn’t move much due to the pain.
NEGATIVE HISTORY
- No H/O Prior infection
- No H/O Injury or fall
- No H/O Blood in urine
- No H/O Fever
PAST HISTORY
- Medical history: – Nothing significant.
- Treatment history: – Nothing significant
- Surgical history: – Nothing significant.
- Allergic history: – Not allergic to drug, diet and dust.
- Covid vaccine: – 2 dose of Covishield vaccine taken.
PERSONAL HISTORY
- Diet – Vegetarian
- Appetite – Good
- Desires – Nothing specific
- Aversion – Nothing specific
- Thirst – 1-2 ltr /day
- Perspiration – More on face and chest
- Bowels – constipation since 5 days
- Urine – 3-4/D, 0-1/N
- Sleep – Sound sleep
- Dreams – Nothing specific
- Thermals – Chilly
MENTAL SYMPTOMS
- Patient gets anger at trifles
- From last few days he’s not having conversation with anyone because he got scolding from his manager 3 days back in front his colleague, he felt embarrassed and think he got scolding for no reason.
- Excess sexual desire and thoughts present
GENERAL PHYSICAL EXAMINATION:
- Built – Well nourished
- Hair – Black
- Eye – Conjunctiva- Pink
- Sclera- Clear
- Nose – No DNS, No polyp
- Ear- No discharge
- Mouth – Gums are pink, No hypertrophy, No bleeding.
- Tongue – Clean, No coating
- Neck – No lymphadenopathy
- Nails – No deformities, No clubbing, No pitting
- Extremities – Normal
PROVISIONAL DIAGNOSIS:
- Torsion of Testis
INVESTIGATIONS:
- USG Scrotum with Doppler
- USG Abdomen Pelvis
FINAL DIAGNOSIS:
Intermittent Torsion of testis
TOTALITY OF SYMPTOMS
- Pain in left side of the testis
- Suppressed anger
- Anger at trifles
- Excess sexual desire
REPORTORIAL ANALYSIS
- Mind – Ailment from – anger, suppressed.
- Mind – Anger- trifles, at
- Mind – Satyriasis
- Male genitalia/sex – Pain – Testis – Left
- Generals – chilly person
DIFFERENTIAL REMEDIES:
| REMEDIES | GRADING |
| STAPHYSAGRIA | 10/5 |
| NATRUM MURIATICUM | 4/7 |
| PHOSPHORUS | 4/7 |
| CONIUM MAC | 4/6 |
| KALI- CARB | 4/6 |
PRESCRIPTION : STAPHISAGRIA 1M OD FOR 3 DAYS
FOLLOW UP
| DATE | OBSERVATION | Rx |
| 27/6/23 | · Pain in the left side of the scrotum reduced by 50%
· Pain while walking persist |
Staphisagria 1M 1 dose |
| 28/6/23 | · Pain in the left side of the scrotum reduced by further.
· Patient is able walk comfortably · No new complaints are seen |
Staphisagria 1M 1 dose |
| 29/6/23 | · Pain in the left side of the scrotum reduced completely.
· Patient is able walk without pain · Left side of the scrotum came back to normal positio |
Pl 6-0-0 |
DISCUSSION:
Torsion of testis is an emergency condition for which surgery is the only option available for the patient. If timely intervention not done it may lead into gangrene. Homoeopathic medicine which is prescribed based on symptom totality gives very good result to the patient without going into the surgery.
CONCLUSION:
For torsion of the testis surgery is the only method of treatment available in conventional system of medicine. Homoeopathy treats a person holistically wherein we take into account mind of a person from where most of the disease prop up or keep up the disease. In the above-mentioned case, patient was asked to undergo for surgery for his complaint to which patient denied and opt for homoeopathy. Taking into account mental picture of the patient along with physical generals and characteristic particular, Staphysagria was prescribed. Patient was completely cured from his complaint
CONSENT FOR PUBLICATION:
Written informed consent obtained from the patient for publication.
REFERENCE:
- Das S. A concise textbook of surgery. 11th ed. Delhi, India: S. Das; 2021
- Das S. A manual on clinical surgery A manual on clinical surgery. 16th ed. New Delhi, India: Jaypee Brothers Medical; 2022.
- Sriram BM. SRB’s clinical methods in surgery. 4th ed. New Delhi, India: Jaypee Brothers Medical; 2022.
Dr Swasthik Jain
PG Scholar Department of Practice of Medicine
Under the Guidance of Dr Praveen Kumar P.D (HOD of Dept of Medicine)
Government Homoeopathic Medical College and Hospital
Dr. Siddhaiah Puranik Road, Basaveshwar Nagar, Bengaluru,560079
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