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testes_torsion

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.

intratunical torsion

  • 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

clinical features

  • 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

Mx

  • 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

prognosis

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

extratunical 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”
testes_torsion.txt · Last modified: 2017/08/20 10:17 (external edit)