A 16-year-old male presents with acute scrotal pain and Doppler ultrasound shows decreased blood flow. What is the most appropriate intervention?

• A. Oral doxycycline
• B. Emergent surgery
• C. Incision and drainage
• D. Scrotal elevation and ice packs

Answer: (B)

Acute scrotum with decreased blood flow on Doppler in a adolescent strongly indicates testicular torsion, a true emergency where time to detorsion determines viability. The correct move is urgent surgical exploration with detorsion and fixation of the testis (and usually fixation of the opposite testis as well) to salvage function and prevent loss. Salvage is highest if detorsion occurs within the first few hours and drops quickly as time passes, so prompt action is crucial. Manual detorsion in some settings can temporarily relieve the twist, but definitive treatment remains surgical. The other options don’t address the underlying ischemia: antibiotics won’t fix torsion, drainage is for abscess, and scrotal elevation/ice packs are supportive but do not treat the torsion.