Testicular Torsion - Case Report

S was born on the 9th September 1982. At the age of 20 he was referred by his GP to a Consultant Urological Surgeon at the Defendant Trust complaining of a painful left testIs. S was subsequently seen on the 7th October 2002 by the Urological Surgeon, who examined him and arranged for an ultrasound scan. Upon further review, following the ultrasound scan on the 2nd December 2002, it was found that S had a normal testIs, and there was no indication of torsion.

In the period following discharge from the hospital, through to the 9th November 2003, S was well, with no further testicular symptoms.

On the 9th November 2003, whilst driving home, a journey of approximately 20 minutes, S's left testicle swelled, to what he described as "an enormous proportion", and the pain was "excruciating".

S arrived home at approximately 9pm. He described his symptoms to his mother, who drove him immediately to the Accident & Emergency Department at the Defendant's hospital. He was recorded as arriving at 2123 hours. He was noted to be "in agony". He was subsequently given an injection of Voltarol, and Codeine Phosphate tablets at 2220 hours.

At 2314 hours the Claimant was examined by a doctor employed by the Defendant. Following examination by the doctor, S was informed that he would need a scan, and he would be guaranteed an appointment within the next 2 weeks. S was then discharged home with painkillers and a prescription for anti-biotics.

On the 11th November 2003 S, having heard nothing from the hospital, rang the scanning department. They had not received any referral letter, and S was invited to ring back. He rang again on the 12th November 2003, and again was informed that no referral letter had been received.

Subsequently, S arranged an appointment with a private Consultant Urologist. He was seen on the 18th November 2003. The Urologist arrived at a diagnosis of a possible missed torsion. Arrangements were made for ultrasound scans, and on the 12th January 2004, S proceeded to excision of the left testicle, and fixing of the right testicle. Due to the risk of haematoma and extrusion, a decision was taken at the time not to insert a prosthetic testicle.

S was subsequently reviewed in clinic by the private Urologist on the 24th February 2004, at which point he was discharged from follow-up.

The Claimant's Allegations

S alleged that the care afforded to him in the Defendant's Accident & Emergency Department on the 9th November 2003 was below the requisite standard and constituted a breach in the Trust's duty of care to him. In particular, it was alleged that in the context of the history of acute onset of pain in a 21 year old with testicular swelling and marked tenderness, a presumptive diagnosis of torsion should have been made, until this is excluded. In view of the history, S alleged that there was a negligent failure to:-

(a) Diagnose or suspect the diagnosis of testicular torsion.

(b) Refer S to the on-call surgical team, or the A&E Consultant.

(c) Proceed to emergency surgical exploration of the testis.

Causation

S noted the onset of the torsion to be timed to be approximately 2100 hours on the 9th November 2003. S presented at the A&E Department by 2123 hours that day. S contended that had the Trust proceeded to emergency surgical exploration then this would have confirmed the diagnosis of torsion. Prompt surgery, within 6 hours of onset of torsion, would have prevented irreversible testicular damage. On the balance of probabilities, the torsion would have been corrected by manipulation of the testis, and the untwisting of the torted spermatic cord, with preservation of the testis.

S contended that as a result of the Defendant's negligence he had lost the testis. No suggestion was made of any long term complications as a result of the Defendant's negligence.

The Claimant submitted a detailed letter of claim to the Defendant, with a Part 36 Offer in settlement.

Outcome of Clinical Negligence Claim

Following investigation by the Defendant, and subsequent negotiations, the matter was concluded with the Claimant accepting the sum of £13,000.00, plus his reasonable legal costs, of which approximately £2,500.00 was for the future medical cost of inserting a prosthetic testes.

S was represented by Eddie Jones of JMW Solicitors, Manchester. The Defendant was represented by the NHS Litigation Authority.

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