Testicular Torsion
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Definition

This is when the spermatic cord (contains the vas deferens, lymphatic vessels, testicular artery, cremasteric artery, panpiniform plexus (veins), nerve to cremaster, testicular nerves) to a testicle twists therefore cutting off the blood supply to the testicle. This is due to a mechanical twisting process which can lead to testicular death. It is a MEDICAL EMERGENCY.

Epidemiology

Can occur at any age but most frequently among neonates and adolescents. It is rare >30 years of age. It occurs in about 1 in 160 males per year.

Risk Factors

  • Bell-clapper deformity (this is where the testicle has formed with no attachment to its surrounding scrotal walls and so is free floating within the tunica vaginalis – the serous sac surrounding the testicle)
  • Large size – either normal variation or the presence of a tumour
  • Sudden change in temperature from hot to cold causing sudden scrotal contraction which can trap the testicle in a rotated position
  • An undescended testis
  • Previous testicular pain

Differential Diagnosis

  • Epididymitis (main differential)
  • Epididymo-orchitis
  • Scrotal oedema
  • Incarcerated inguinal hernia

Presentation

  • Acute onset of diffuse pain – can be in the scrotum, groin, lower abdomen or the inguinal region.
  • Swollen testis
  • Testicular tenderness
  • Fever
  • Nausea
  • Vomiting

Investigations

  • Doppler Ultrasound Scan can be done to look at the flow of testicular blood – this helps to rule out epididymitis where the flow will be present. In torsion, there will be absent blood flow.
  • Cremasteric reflexshould be absent in true torsion but may only be diminished so this is not an accurate investigation.
  • Surgical exploration is mandatory unless torsion can be excluded.

Treatment

  • Surgical emergency– immediate intervention required to detort the testis.

Prognosis

  • If treated within 6 hours – 90% chance of survival of the testicle surviving; 12 hours – 50%; 24 hours – 10%; >24 hours – 0%.

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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