Testicular torsion Flashcards
1
Q
What is testicular torsion?
A
Twisting of the testicle causing venous occlusion and enragement as well as arterial ischaemia and infarction.
2
Q
Aetiology of testicular torsion?
A
- Trauma
- Cryptorchidism
- “Bell clapper” deformity
- Many occur in sleep
3
Q
Hx of testicular torsion?
A
- Acute onset severe scrotal pain and swelling
- N&V
- +/- swelling, precipitating event
4
Q
Examination testicular torsion?
A
- Retracted and transverse testicle (horizontal lie)
- Negative Phren’s sign (no relief with elevation)
- Absent cremasteric reflex
- High riding testicle
- Thickened spermatic cord
- Epididymis not posterior to testicle
5
Q
Ix in ?testicular torsion?
A
- U/S w/ Doppler over testicular artery
- Urinalysis
- Surgical exploration
6
Q
Treatment testicular torsion?
A
- Emergency manual detorsion (rotate outward) with elective bilateral orchidopexy
- Failure of manual detorsion: surgical detorsion with orchidopexy
- Orchiectomy if poor prognosis
7
Q
What is torsion of testicular appendix?
A
-Twisting of testicular / epididymal vestigial appendix
8
Q
Signs of testicular appendix torsion?
A
- Clinically similar to testicular torsion but vertical lie and cremaster reflex preserved
- “blue dot sign” (blue infarcted appendage seen through scrotal skin)
- Localised pain to superior pole of testis
9
Q
Rx torsion of testicular appendix?
A
- Analgesia: most will subside over 5-7/7 (NSAIDs)
- Surgical exploration and excision if refractory pain
10
Q
What are the types of testicular torsion?
A
- Intravaginal
- Extravaginal (neonates)
11
Q
What is the most common cause of acute scrotum in pre-pubertal boys?
A
Torsion of testicular appendage
