Testicular Torsion
Torsion occurs when the spermatic cord twists and compromises the blood
supply to the testicle. It occurs most commonly in the adolescent age
group and can follow minor trauma. The patient typically develops acute
onset severe unilateral testicular pain. The pain may also radiate to
the lower abdominal with nausea and vomiting. Examination reveals a
swollen exquisitely tender testicle, which is often found riding high
in the scrotum.
This requires an urgent urology consult. If the diagnosis
of torsion is suspected surgical exploration is necessary.
The spermatic cord must be untorted within 6 hours if the testicle is
to be saved. Whether or not the testicle has undergone torsion it should
be sutured down to the scrotal skin to preclude any subsequent torsion
and any uncertainty over the diagnosis should the pain recur. Once the
testicle has been surgically tacked down it should never twist again.
The opposite testicle should also be sewn down since the anatomic abnormality
that caused torsion on one side may be present bilaterally.
If, however, the testicle does not appear viable intra operatively it
should be removed. It has been shown that leaving a nonviable testicle
in situ will significantly decrease the patient's future fertility.
This is most likely due to an autoimmune phenomenon which occurs as
the body is exposed for the first time the its own sperm.
Torsion of the testicular appendages can also occur. The appendix testis
is by far the most common of the appendages to twist. It presents as
acute onset unilateral scrotal pain in the adolescent. Usually a tender
pea-sized nodule can be palpated at the upper pole of the ipsilateral
testis. If the appendix testis has infarcted, a small blue dot can sometimes
be seen through the scrotal skin - blue dot sign. Surgical exploration
is usually required. If an infarcted appendix is found it should simply
be excised.
The differential diagnosis includes Epididymitis
