Testicular torsion in the medicolegal perspective: Why is the diagnosis missing?

BACKGROUND: By examining patients with testicular torsion (TT) that caused problems in medicolegal terms, the present study aims to define markers causing medical neglect or malpractice in similar conditions and perform a retrospective examination to characterize the medical aspects of patients with TT.
METHODS: In this study, 53 patients who underwent orchiectomy for TT following interventions made between 2004 and 2019 in different hospitals of Turkey and had satisfactory clinical findings in their files based on medicolegal inspections were included.
RESULTS: The median age of the patients was nine years. Twenty-three (43.4%) of the patients had TT on the left side, 29 (54.7%) had TT on the right side, and one (1,9%) patient had bilateral TT. It was noticed that 31 (58.5%) patients had epididymo-orchitis (EO), seven patients had (13.2%) urinary infection, five (9.4%) patients had a hydrocele, and four (7.5%) patients had renal colic, and the others had testicle contusion, gastroenteritis, inguinal hernia, and acute appendicitis as misdiagnoses. The mean time that passed between admission and TT diagnosis was detected as 59±11.2 hours. A statistically significant relation was detected between the branch of the physician who first evaluated the patients and the presence of performing scrotal examination and imaging during admission. The ratio of physical scrotal examinations by emergency service physicians was lower than with the urologists. Among the preliminary examiner allowed to be an advanced evaluation for the possibility of missing diagnosis by an independent specialist physicians, 25 (47.2%) were urologists, 22 (41.5%) were emergency service physicians, four (7.5%) were pediatricians, and two (3.8%) were radiologists.
CONCLUSION: Physicians should perform the required evaluations for a suitable diagnosis and treatment by putting aside their medicolegal concerns and prevent the problems by giving priority to patient health. For the correct diagnosis and proper management of TT, it is necessary to increase the information levels of physicians, and patients should be explored urgently in the event of any clinical suspicion.

Adli týp perspektifinden testis torsiyonu: Taný neden eksik?

AMAÇ: Medikolegal açýdan sorun oluþturmuþ testis torsiyonu (TT) olgularýný inceleyerek, bu gibi durumlarda týbbi ihmal veya yanlýþ uygulamaya neden olmuþ belirteçleri tanýmlamak ve testis torsiyonu olgularýnýn týbbi yönlerini karakterize etmek amacýyla bir inceleme yaparak sizlere sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 2004–2019 yýllarý arasýnda Türkiye’nin farklý hastanelerinde gerçekleþtirilmiþ müdahaleler sonucu, orþiektomi olan ve Türkiye Cumhuriyeti Adalet Bakanlýðý Adli Týp Kurumu’nda týbbi uygulama hatasý bakýmýndan incelenen 53 testis torsiyonu olgusuna ait veriler geriye dönük olarak deðerlendirildi.
BULGULAR: Olgularýn median yaþý dokuz yýldýr. Torsiyon olgularýn %43.4’ünün (n=23) sol tarafýnda, %54.7’sinin (n=29) sað tarafýnda, %1.9’unun (n=1) ise iki taraflý testis torsiyonu izlenmiþtir. Ön tanýlar incelendiðinde; %58.5 (n=31) epididimorþit, %13.2 (n=7) üriner enfeksiyon, %9.4 (n=5) hidrosel, %7.5 (n=4) renal kolik ve diðer ön tanýlar testis kontüzyonu, gastroenterit, inguinal herni ve akut apandisit olarak saptanmýþtýr. Baþvuru ile TT tanýsý arasý geçen süre, ortalama 59.0±11.2 saattir. Hastayý ilk deðerlendiren doktor ile baþvuruda skrotal muayene yapma durumu arasýnda istatistiksel olarak anlamlý iliþki saptanmýþtýr (p=0.008; p<0.01). Acil servis hekimlerinde skrotal muayene yapma oraný ürologlardan düþüktür. Malpraktis açýsýndan baðýmsýz bir uzman tarafýndan ileri incelemeye gerek görülen ve adli týp kurumuna gelen hasta dosyalarýnda suçlanan hekimler; 25 (%47.2) üroloji uzmaný, 22 (%41.5) acil servis uzmaný, dört (%7.5) pediatrist ve iki (%3.8) radyoloji uzmanýydý.
TARTIÞMA: Hekimler medikolegal kaygýlarýndan önce hasta saðlýðý açýsýndan bu aksaklýlýklarýn mümkün olduðu yaþanmamasý için doðru taný ve tedavi için gerekli deðerlendirmeleri yapmalýdýr. Doðru taný için hekimlerin bilinçlendirilmesi, hekimlerin bilgi ve bilinç düzeyinin arttýrýlmasý ve sürecinin zamana karþý olmasý nedeniyle klinik olarak þüphe edilmesi halinde hastanýn acil ameliyat edilmesi uygun gözükmektedir.