5. Torsion Testis Flashcards
Torsion Testis
- Alternative name
- Etiology
- PATHOLOGY
- CLINICAL PICTURE
- Differential Diagnosis
- INVESTIGATIONS
- Treatment
Alternative name for Torsion Testis
- Torsion of the spermatic cord
* Winter syndrome
Etiology of Torsion Testis
- PREDISPOSING FACTORS
* PRECIPITATING FACTORS
PREDISPOSING FACTORS in Etiology of Torsion Testis
- Arrested and ectopic testis
- Inversion of the testis
- Long mesorchium
- High investment of the tunica vaginalis
Pathogenesis of Arrested and ectopic testis in PREDISPOSING FACTORS in Etiology of Torsion Testis
The testis is improperly fixed.
Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis
- Superior inversion
- Anterior inversion
- Lateral inversion
- Loop inversion
Pathogenesis of Superior inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis
The longitudinal axis of the testis is directed forwards so that the epididymis lies horizontally.
Pathogenesis of Anterior inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis
Epididymis lies anteriorly, the body of the testis & the tunica vaginalis posteriorly.
Pathogenesis of Lateral inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis
Epididymis lies laterally
Pathogenesis of Loop inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis
Epididymis encircles the testis like a sling
Long mesorchium in PREDISPOSING FACTORS in Etiology of Torsion Testis
The body of the testis is separated from the epididymis by a long mesorchium.
High investment of the tunica vaginalis in PREDISPOSING FACTORS in Etiology of Torsion Testis
- Normal anatomy
* Pathogenesis
Normal anatomy in High investment of the tunica vaginalis in PREDISPOSING FACTORS in Etiology of Torsion Testis
In most males, the testis is attached posteriorly
to the inner lining of the scrotum.
Pathogenesis of High investment of the tunica vaginalis in PREDISPOSING FACTORS in Etiology of Torsion Testis
- In this anomaly, the testis is free floating in
the tunica vaginalis, only attached to the
spermatic cord, like a bell clapper. - Causes the testis to hang within the tunica like a clapper in a bell.
PRECIPITATING FACTORS in Etiology of Torsion Testis
Factors causing Contraction of cremasteric muscles
- Sudden straining.
- lifting a heavy object.
- Trauma.
- Sudden exposure to cold weather
The reason why Torsion testis is sometimes called “winter syndrome”
- This is because it often happens in winter, when it is cold outside.
- The scrotum of a man who has been lying in a warm
bed is relaxed. The sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion.
PATHOLOGY of Torsion Testis
1) Testis
2) Spermatic cord
3) Skin of the scrotum
Pathology of testis in PATHOLOGY of Torsion Testis
- Direction of Torsion
* Morphology of Torsion testis
Direction of Torsion in Pathology of testis in PATHOLOGY of Torsion Testis
- Usually the testis twists in a direction away from the septum dartos
- i.e. clockwise on the right & anti-clockwise on the left,
- owing to the direction of the spirally attached cremasteric muscle.
Morphology of Torsion testis in Pathology of testis in PATHOLOGY of Torsion Testis
It becomes edematous, congested and finally gangrenous
Pathology of Spermatic cord in PATHOLOGY of Torsion Testis
Thrombosis of the vessels will occur if torsion is not reduced
Pathology of Skin of the scrotum in PATHOLOGY of Torsion Testis
Becomes red & edematous.
CLINICAL PICTURE of Torsion Testis
- Symptoms
* Examination
Symptoms in CLINICAL PICTURE of Torsion Testis
- Sudden severe agonizing pain in the groin and lower abdomen
- Vomiting (once or twice, not persistent).
- Abdominal distension
Pathogenesis of Abdominal distension in Symptoms in CLINICAL PICTURE of Torsion Testis
from reflex Paralytic ileus
Examination in CLINICAL PICTURE of Torsion Testis
A. Torsion of a completely descended testis
B. Torsion of an incompletely descended testis
Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
- The testis is swollen, tender & higher up in position
- The scrotum is red, edematous & dimpled.
- There is tachycardia & sometimes shock.
- Simulation of acute epididymo-orchitis
Pathogenesis of dimpled scrotum in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
Contraction of Dartos muscle
Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
Difference between Torsion testis and acute epididymo-orchitis
Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
- Elevation of the scrotum
- Temperature
- Cremasteric reflex
* Note on the Cremasteric reflex
Elevation of the scrotum in Torsion testis in Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
exaggerates the pain “+ve Prehn’s sign”.
Elevation of the scrotum in acute epididymo-orchitis in Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
relieves pain as it decreases edema
Temperature in Torsion testis in Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
normal or slightly elevated.
Temperature in acute epididymo-orchitis in Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
High
Cremasteric reflex in Torsion testis in Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
usually absent.
Cremasteric reflex in acute epididymo-orchitis in Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
Present
Note on the Cremasteric reflex in Difference between Torsion testis and acute epididymo-orchitis in Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
- The presence of the cremasteric reflex does not eliminate testicular torsion from a differential diagnosis,
- but it does broaden the possibilities to include epidydimitis, or other causes of scrotal and testicular pain
Examination of Torsion of an incompletely descended testis in Examination in CLINICAL PICTURE of Torsion Testis
- Inguinal swelling which is irreducible, no impulse on cough, tender and tense.
- It is very similar to strangulated hernia but the corresponding side of the scrotum is empty.
Differential Diagnosis of Torsion Testis
- Acute epididymo-orchitis.
- Strangulated inguinal hernia )> C/P of Intestinal obstruction
- Torsion of hydatid of Morgagni “appendix testis”.
- Idiopathic scrotal edema.
Torsion of hydatid of Morgagni “appendix testis” in Differential Diagnosis of Torsion Testis
- Clinical picture
* Treatment
Clinical picture of Torsion of hydatid of Morgagni “appendix testis” in Differential Diagnosis of Torsion Testis
- Clinically mimics torsion testis.
* 1/3 of patients present with a palpable “blue dot” discoloration.
Treatment of Torsion of hydatid of Morgagni “appendix testis” in Differential Diagnosis of Torsion Testis
Immediate operation with ligation and excision of the twisted appendix of the testis
INVESTIGATIONS of Torsion Testis
- Urgent scrotal duplex & U/S is diagnostic.
2. Urgent urine analysis.
Urgent scrotal duplex in INVESTIGATIONS of Torsion Testis
show No flow in testicular artery
Urgent urine analysis in INVESTIGATIONS of Torsion Testis
Pyuria in cases of acute epididymo-orchitis.
Treatment of Torsion Testis
- Indication
* Operative management
Indication of Treatment of Torsion Testis
The condition is highly emergency and infraction of the testes occurs in 6 hrs
Operative management in Treatment of Torsion Testis
- Through an inguino-scrotal incision the torsion is undone and
- Examination of testis
Examination of testis in Operative management in Treatment of Torsion Testis
- Viable testis
2. Non viable testis
Management of Viable testis in Examination of testis in Operative management in Treatment of Torsion Testis
- The tunica vaginalis is everted and the testis is fixed to the bottom of the scrotum to prevent recurrence.
- Orchiopexy of the opposite testis at the same time
The reason of Orchiopexy of the opposite testis at the same time in Management of Viable testis in Examination of testis in Operative management in Treatment of Torsion Testis
as the anatomical variation responsible for torsion is likely to be bilateral.
Management of Non Viable testis in Examination of testis in Operative management in Treatment of Torsion Testis
- Orchiectomy above the twist.
2. Orchiopexy of the opposite testis “most important”
most important step in Management of Non Viable testis in Examination of testis in Operative management in Treatment of Torsion Testis
Orchiopexy of the opposite testis
