torsion of testes

introduction

intratunical torsion of the testes is a surgical emergency as infarction of the testes increases with time, and with durations exceeding 4 hours from onset, prognosis becomes poor
patients with suspected torsion of testes are usually triaged as code 2 and surgical consult sought ASAP without delaying for ultrasound examination.

most commonly occurs in post-pubertal boys and young men
in contrast, the more benign torsion of a scrotal appendage such as a hydatid of Morgagni tends to occur mainly in pre-pubertal boys.
1/160 males
75% in 2nd decade
left testes affected twice as often as right

pain is almost always the first symptom, but may be only in the lower quadrant and patient may not indicate there is pain in the scrotum - hence the scrotum should be palpated in all adolescents and young men who present with lower abdominal pain.
nausea and vomiting may occur
history of trauma in 20%
prior episodes in 30%
testes is exquisitely tender but may look normal initially and then develop swelling and oedema
“bell clapper” testicle has a transverse lie
testis redux

in adolescents and young adults, NO investigation should be done as this will only delay time to theatre
contact surgeon ASAP
nil orally
analgesia as needed
some suggest attempting reduction of torsion whilst awaiting theatre

infarction and subsequent atrophy and non-function is proportional to duration of torsion

these occur in neonates or newborns at less than 4 weeks of age corrected for dates as the scrotal contents are not adherent to the scrotal sac
testis is often infarcted at birth
prenatal torsion results in “vanishing testis”