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Surgery.(General 1).Scrotum > 5. Torsion Testis > Flashcards

5. Torsion Testis Flashcards

1
Q

Torsion Testis

A
  • Alternative name
  • Etiology
  • PATHOLOGY
  • CLINICAL PICTURE
  • Differential Diagnosis
  • INVESTIGATIONS
  • Treatment
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2
Q

Alternative name for Torsion Testis

A
  • Torsion of the spermatic cord

* Winter syndrome

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3
Q

Etiology of Torsion Testis

A
  • PREDISPOSING FACTORS

* PRECIPITATING FACTORS

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4
Q

PREDISPOSING FACTORS in Etiology of Torsion Testis

A
  1. Arrested and ectopic testis
  2. Inversion of the testis
  3. Long mesorchium
  4. High investment of the tunica vaginalis
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5
Q

Pathogenesis of Arrested and ectopic testis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A

The testis is improperly fixed.

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6
Q

Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A
  1. Superior inversion
  2. Anterior inversion
  3. Lateral inversion
  4. Loop inversion
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7
Q

Pathogenesis of Superior inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A

The longitudinal axis of the testis is directed forwards so that the epididymis lies horizontally.

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8
Q

Pathogenesis of Anterior inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A

Epididymis lies anteriorly, the body of the testis & the tunica vaginalis posteriorly.

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9
Q

Pathogenesis of Lateral inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A

Epididymis lies laterally

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10
Q

Pathogenesis of Loop inversion in Inversion of the testis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A

Epididymis encircles the testis like a sling

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11
Q

Long mesorchium in PREDISPOSING FACTORS in Etiology of Torsion Testis

A

The body of the testis is separated from the epididymis by a long mesorchium.

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12
Q

High investment of the tunica vaginalis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A
  • Normal anatomy

* Pathogenesis

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13
Q

Normal anatomy in High investment of the tunica vaginalis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A

In most males, the testis is attached posteriorly

to the inner lining of the scrotum.

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14
Q

Pathogenesis of High investment of the tunica vaginalis in PREDISPOSING FACTORS in Etiology of Torsion Testis

A
  • 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.
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15
Q

PRECIPITATING FACTORS in Etiology of Torsion Testis

A

Factors causing Contraction of cremasteric muscles

  1. Sudden straining.
  2. lifting a heavy object.
  3. Trauma.
  4. Sudden exposure to cold weather
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16
Q

The reason why Torsion testis is sometimes called “winter syndrome”

A
  • 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.
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17
Q

PATHOLOGY of Torsion Testis

A

1) Testis
2) Spermatic cord
3) Skin of the scrotum

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18
Q

Pathology of testis in PATHOLOGY of Torsion Testis

A
  • Direction of Torsion

* Morphology of Torsion testis

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19
Q

Direction of Torsion in Pathology of testis in PATHOLOGY of Torsion Testis

A
  • 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.
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20
Q

Morphology of Torsion testis in Pathology of testis in PATHOLOGY of Torsion Testis

A

It becomes edematous, congested and finally gangrenous

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21
Q

Pathology of Spermatic cord in PATHOLOGY of Torsion Testis

A

Thrombosis of the vessels will occur if torsion is not reduced

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22
Q

Pathology of Skin of the scrotum in PATHOLOGY of Torsion Testis

A

Becomes red & edematous.

23
Q

CLINICAL PICTURE of Torsion Testis

A
  • Symptoms

* Examination

24
Q

Symptoms in CLINICAL PICTURE of Torsion Testis

A
  1. Sudden severe agonizing pain in the groin and lower abdomen
  2. Vomiting (once or twice, not persistent).
  3. Abdominal distension
25
Q

Pathogenesis of Abdominal distension in Symptoms in CLINICAL PICTURE of Torsion Testis

A

from reflex Paralytic ileus

26
Q

Examination in CLINICAL PICTURE of Torsion Testis

A

A. Torsion of a completely descended testis

B. Torsion of an incompletely descended testis

27
Q

Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis

A
  • 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
28
Q

Pathogenesis of dimpled scrotum in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis

A

Contraction of Dartos muscle

29
Q

Simulation of acute epididymo-orchitis in Examination of Torsion of a completely descended testis in Examination in CLINICAL PICTURE of Torsion Testis

A

Difference between Torsion testis and acute epididymo-orchitis

30
Q

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

A
  1. Elevation of the scrotum
  2. Temperature
  3. Cremasteric reflex
    * Note on the Cremasteric reflex
31
Q

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

A

exaggerates the pain “+ve Prehn’s sign”.

32
Q

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

A

relieves pain as it decreases edema

33
Q

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

A

normal or slightly elevated.

34
Q

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

A

High

35
Q

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

A

usually absent.

36
Q

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

A

Present

37
Q

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

A
  • 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
38
Q

Examination of Torsion of an incompletely descended testis in Examination in CLINICAL PICTURE of Torsion Testis

A
  • 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.
39
Q

Differential Diagnosis of Torsion Testis

A
  1. Acute epididymo-orchitis.
  2. Strangulated inguinal hernia )> C/P of Intestinal obstruction
  3. Torsion of hydatid of Morgagni “appendix testis”.
  4. Idiopathic scrotal edema.
40
Q

Torsion of hydatid of Morgagni “appendix testis” in Differential Diagnosis of Torsion Testis

A
  • Clinical picture

* Treatment

41
Q

Clinical picture of Torsion of hydatid of Morgagni “appendix testis” in Differential Diagnosis of Torsion Testis

A
  • Clinically mimics torsion testis.

* 1/3 of patients present with a palpable “blue dot” discoloration.

42
Q

Treatment of Torsion of hydatid of Morgagni “appendix testis” in Differential Diagnosis of Torsion Testis

A

Immediate operation with ligation and excision of the twisted appendix of the testis

43
Q

INVESTIGATIONS of Torsion Testis

A
  1. Urgent scrotal duplex & U/S is diagnostic.

2. Urgent urine analysis.

44
Q

Urgent scrotal duplex in INVESTIGATIONS of Torsion Testis

A

show No flow in testicular artery

45
Q

Urgent urine analysis in INVESTIGATIONS of Torsion Testis

A

Pyuria in cases of acute epididymo-orchitis.

46
Q

Treatment of Torsion Testis

A
  • Indication

* Operative management

47
Q

Indication of Treatment of Torsion Testis

A

The condition is highly emergency and infraction of the testes occurs in 6 hrs

48
Q

Operative management in Treatment of Torsion Testis

A
  1. Through an inguino-scrotal incision the torsion is undone and
  2. Examination of testis
49
Q

Examination of testis in Operative management in Treatment of Torsion Testis

A
  1. Viable testis

2. Non viable testis

50
Q

Management of Viable testis in Examination of testis in Operative management in Treatment of Torsion Testis

A
  1. The tunica vaginalis is everted and the testis is fixed to the bottom of the scrotum to prevent recurrence.
  2. Orchiopexy of the opposite testis at the same time
51
Q

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

A

as the anatomical variation responsible for torsion is likely to be bilateral.

52
Q

Management of Non Viable testis in Examination of testis in Operative management in Treatment of Torsion Testis

A
  1. Orchiectomy above the twist.

2. Orchiopexy of the opposite testis “most important”

53
Q

most important step in Management of Non Viable testis in Examination of testis in Operative management in Treatment of Torsion Testis

A

Orchiopexy of the opposite testis

Surgery.(General 1).Scrotum (8 decks)

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