Testicular Torsion

INTRODUCTION:

Testicular torsion or torsion of the testis is twisting of testis leading to occlusion of blood vessels which if not diagnosed and operated can lead to testicular necrosis. It is one of the important cause of acute scrotum and is a surgical emergency.

ETIOLOGY:

There is bi-modal distribution in the age:

Neonatal age group- Extravaginal testicular torsion: Entire spermatic cord twists around its axis.

Adolescents- Intravaginal testicular torsion: because of abnormal fixation of testis with epididymis (Bell-clapper deformity), torsion of spermatic cord occurs within tunica vaginalis

SYMPTOMS:

1. Acute scrotal pain

2. Nausea/Vomiting

3. Pain in lower abdomen radiating to testis

4. previous H/O similar type of pain swelling

ON EXAMINATION:

- high degree of suspicion

- firm, high lying testis with tenderness

- transverse orientation of testis

- absence of cremasteric reflex

- scrotal edema

INVESTIGATION:

If there is high index of suspicion, prompt surgical exploration is mandatory.

In doubtful situation Color Doppler US study

TREATMENT:

Bilateral orchiopexy:

Detorsion of the affected testis with orchiopexy/ orchiectomy depending upon the situation. At the same time other testis is also fixed as it has high chances of undergoing torsion