Acute Scrotum: Testicular Torsion

Question 1

main 3 ddx of acute scrotum?

Answer 1

• testicular torsion
• epididymo-orchitis
• torsion of testicular appendage (hydatid of morgagni)

Question 2

Risk factors?

Answer 2

• exertion
• minor trauma
• bell clapper deformity

Question 3

epidemiology?

Answer 3

bimodal age peak:

• neonates
• adolescence

often triggered by activity

Question 4

presentation?

Answer 4

urological emergency- 5-6hr window before damage from ischaemia is irreversible

• acute onset unilateral testicular pain + swelling
• may present as lower abdo pain

Question 5

O/E?

Answer 5

• firm testicle
• acutely tender
• scrotal erythema
• absent cremasteric reflex
• abnormal lie
  
  • horizontal lie
  • elevated testicle

Question 6

Mx?

Answer 6

• call urology surgical team ASAP
• take to theatre
  
  • immediate surgical scrotal exploration
    
    • untwist testicle
    • both testicles are fixed in correct position to prevent further episodes (orchiplexy)
    • if testicle necrotic–> orchiectomy

Question 7

Complication?

Answer 7

• loss of testicle
• subfertility / infertility

Question 8

what is bell clapper deformity?

Answer 8

• normally testicle fixed posteriorly to tunica vaginalis
• in bell clapper this fixation is absent
  
  • allows testicle to rotate within tunica

Question 9

what is torsion of testicular appendage?

Answer 9

• Twisting of vestigial appendage that is located along the testicle
• can mimic testicular torsion
• O/E: blue dot sign on testicle