Clinical assessment and risk stratification

Any patient presenting with an abdominal complaint should have a scrotal examination considered as part of their assessment. A scrotal and genitalia examination must have a chaperone present, and the RCEM Best Practice Guideline (4) covers this in greater detail. Of note, the RCEM Guideline may advocate a stricter approach than that practiced in some departments, and provides food for thought about the pressure of service delivery in the context of documentation and chaperones.

Key points with chaperoning include briefing your chaperone as to what you are doing and why (they may not have chaperoned for a testicular exam previously), ensuring the cubicle or room you are using provides sufficient privacy (a chaperone is useful to prevent any interruptions) and ensure you document (preferably by name) who chaperoned, in case you need to refer to your notes in the future.

Testicular examination is a part of the assessment, and patients should have been flagged up early at triage if concerns of torsion or sepsis are present and seen as a priority. A general examination, which includes the abdomen, groin and scrotum, should be sufficient in gathering enough information to help confirm your differentials from the history.

It is vitally important to fully expose patients to perform a thorough examination, specifically in those patients with large aprons or folds, in whom there could easily be gangrene present, but hidden. Make note of the colour and feel of the skin and soft tissues, which can help confirm the diagnosis (subcutaneous emphysema in the groin is NOT a normal finding!)

Learning Bite

Always have a chaperone, and ensure all appropriate areas are examined fully to not miss signs of gangrene.