Testicular Torsion

Question 1

Common age presentation?

Answer 1

12-18yo

Question 2

Risk factors?

Answer 2

1. Cryptorchidism
2. Maldescended testis hanging like a bell clapper within the tunica vaginalis

Question 3

Clinical Presentation?

Answer 3

1. Acute abdomen with acute onset of testicular pain and swelling
2. N/V
3. Precipitated by trauma, cycling, straining, coitus

-Physical Exam-
1. Swollen and Tender Scrotum
2. High riding in scrotum with transverse lie
3. Absent cremasteric reflex
4. Negative Prehn Sign - no pain relief with lifting of affected testis
– +ve sign suggests epididymitis
5. Testis not definable from epididymis, opaque on transillumination, tender

Question 4

Differentials Diagnosis?

Answer 4

1. Epididymis
2. Torsion of Testicular Appendage
3. Strangulated Inguinoscrotal Hernia

Question 5

Investigations?

Answer 5

Colour Doppler Ultrasound

Question 6

Management?

Answer 6

1. Emergency Exploration if Doppler US -ve for flow or high index of clinical suspicion
   - Untwisting of affected testis and bilateral orchidopexy
   - Warm up with warm pad to see reperfusion or check with doppler after untwisting
   - If dead, excise and replace with prosthesis