Testicular Torsion

Question 1

Cause of testicular torsion

Answer 1

Usually secondary to minor injury

Question 2

Presentation of testicular torsion

Answer 2

Usually 10-25yrs
Sudden onset severe pain in one testis
May have lower abdominal pain (testis supplied by T10)
Nausea/vomiting
May have history of previous testicular pain or torsion

Question 3

Examination of testicular torsion

Answer 3

Inflammation of one testis: hot, swollen, extremely tender

Testis rides high and lies transversely

Question 4

Differential diagnoses of testicular torsion

Answer 4

1. Epididymo-orchitis:
  Older patient
  UTI symptoms
  More gradual onset
2. Torted Hydatid of Morgagni:
  Remnant of Mullerian duct 
  Younger patient
  Less pain
  Tiny blue dot visible on scrotum
3. Tumour
4. Trauma
5. Strangulated hernia
6. Appendicitis

Question 5

Investigation of testicular torsion

Answer 5

Doppler ultrasound may demonstrate absence of flow but must not delay surgical exploration

Question 6

Treatment of testicular torsion

Answer 6

Surgical emergency
4-6h window from onset of pain to salvage testis
Inform senior
Consent for possible orchidectomy
Bilateral orchidopexy: suture testes to scrotum
If no torsion found and epididymo-orchitis: take fluid
sample from scrotum for bacteriology and treat with antibiotics.