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Have sharp pain in abdomen. Ultrasound showed normal. What should I do?

Apr 2013
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General Surgeon
Practicing since : 2008
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Need advices and opinions -
Two days back i.e. 2nd July, I had sharp left testicle pain radiating up to abdomen. The pain existed only in a few body positions like how I sat or stand. I rushed to hospital thinking that potentially it could be something serious. I was seen by an urologist and he did a physical examination on the testicle and he said it looked fine. He asked me to get an ultrasound - testicles and ultrasound - KUB. Both the reports turned out to be normal. I pushed the doctor for finding answers and asked him whether it could be a torsion. He said it doesn't look like. He noted this in his report : "No clinical observations indicate/suggest that there was a spontaneous de-torsion". He though told me that I could elect for fixing the testes by surgery.

1. Don't you think fixing the testes is an aggressive treatment when there was no torsion involved?. He was a surgeon, so am not sure why he even suggested that option.
2. After a day i.e. on 3rd July, my left testicle pain completely subsided and pain switched to right testicle and it was subtle. Today even this pain got subsided.

What do you think I should do next as I am little tensed?. Should I do a follow-up with the surgeon?
Posted Thu, 25 Jul 2013 in Urinary and Bladder Problems
Answered by Dr. Ivan R. Rommstein 23 minutes later
Hi and welcome to XXXXXXX Thank you for your query.

It doesnt sound like XXXXXXX In this case there would be constant pain with testicle swelling. This is more like neural pain which may occur after muscle sprain around the ilioinguinal and genitofemoral nerve or nerve compression near lumbar spine nerve roots. Second possibility is reducible,small inguinal hernia. Also, herpes infection and rarely some other can cause such sudden intermitent pain.
I dont recommend testicular fixation if there is no clear indication for it. This is minor procedure, but if there is no evidence of torsion there is no reason to do it. YOu can wait and see will it happen again. If does, you should do testis scintigraphy for more detailed evaluation. TO check neural cause you need spine and inguinal MRI,but just go step by step, nothing serious can happen in short time. WIsh you good health. If you have any questions I ll be glad to help. Regards
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Follow-up: Have sharp pain in abdomen. Ultrasound showed normal. What should I do? 16 minutes later
Thanks Doctor XXXXXXX for your reply.

I have following follow-up questions:
1. Do you think testis scintigraphy is better than color doppler ultrasound scrotal and color doppler ultrasound testis as the latter are the tests the hospital performed?.
2. Urologist told me even if there was a slight doubt around torsion, he would have done the surgery. He said there was not even a slight indication of torsion. Saying so, why did he even suggested testicular fixation?.
3. I had a herniated disc at L2-L3 level in the past and got operated. Could this be any cause?.
4. Also what I observe is when I have either high rates of ejaculation or when I abstain from sex for long, something or the other pain is felt in groin/testis region. Could be prostrate related?.
5. I have been to Urologist and Surgeon for getting myself checked for inguinal hernia, but doctors said they don't see any hernia.I read something called sports hernia or very small hernia can cause these kinds of pains randomly.

Thanks a lot for patience again.
Answered by Dr. Ivan R. Rommstein 43 minutes later
1. of course it is better, it is much more sophisticated test than doppler which is operator dependent. I am not sure is it available in your place,but some institution do it when there is suspicion of testis torsion or decreased blood flow. This is not the first test to do,but if your sympotms persist,this is one of the options.

2. There are few ultrasonographic and physical signs of torsion and he obviously didnt notice any of this. This procedure can be done as a prevention, maybe this is what he meant.
3.Yes,it could be the cause definitely. So,if it occur again,you should consider spine evaluation.
4. This can be normal,but also can indicate prostatitis,urinary infection,STD, enlarged prostate or epididimitis. YOu should do urine analysis to rule out uroinfection and prostate ultrasound. Usually such young people dont have prostate related problems,but it is possible.
5. Yes,it can cause such pain. If hernia is reduced at the time of test, it cant be seen on ultrasound or by physical exam. If you notice some bump in ingunal area while coughing it suggests hernia,but small hernias cant be detected somtimes at all and can cause pain in inguinum and testis.
I am sure that the right diagnosis will be established,just need to be patient. Now, wait for some time and see will symptoms recur. If yes, you should do these tests I ve mentioned.
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Follow-up: Have sharp pain in abdomen. Ultrasound showed normal. What should I do? 18 hours later
Thanks again for detailed response. On 5) from above, I don't see any bumps while coughing and have undergone coughing tests by urologist.

I have the following follow-up questions-
1. Why do you think pain has alternated from left to right testicle?. The pain is not severe, but there is some pain.

Also, I think you are right that it could be neural pain as the pain alternates and am feeling weird sensations in spine too?..

Also, the pain is sort of subsiding, am thinking of ignoring it for a bit as no tests seems anything serious..I hope things get resolved sooner.
Answered by Dr. Ivan R. Rommstein 5 hours later

If there is spinal canal compression than it can cause bilateral pain because then both nerves for legs are affected, this is not strange. But also, urinary infection or prostate issue can cause bilateral pain.
You dont have to hurry with tests, nothing serious can suddenly happen. Try to do XXXXXXX back exercises and avoid heavy lifting in next several weeks.
Hope you will feel better soon.
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