Contents
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%.