Testicular
torsion
Management
Definition
Acute twisting of the spermatic cord
causing ischemia to the testes
SURGICAL EMERGENCY
Epidemiology
True torsion uncommon,
occurs post pubertal
Pathophysiology
Clinical
presentation
Testicle
Spermatic cord twists, cutting off
blood supply to the testicle
Ischemia and necrosis
Appendix (Hydatid of Morgani)
Remenant of Mullerian ducts on upper pole of testis
Acute painful testes
(may locate to abdomen/groin)
Swollen testicle
Diagnosis
Examination
Investigations
History
Genital exam
Erythematous, oedematous, tender, high lying testis,
blue dot/lump of testicular skin (appendix torsion)
Bedside
Obs (fever)
Imaging
Doppler USS testes (only if think unlikely)
Surgical exploration: diagnostic
PMH
Known medical conditions
Previous undescended testis
Previous surgery
DH
Meds, allergies
PC/HPC
Pain (SOCRATES)
Swelling, triggering activity
FH
Testicular disease, cancers
SH
Living arrangements, occupation/school,
leisure activities, smoking, alcohol
Appendix torsion more common,
affects pre pubertal
Conservative
Information, advice, support
Medical
Surgical
Analgesia
Indication: pain
E.g. paracetamol, ibuprofen
Fixation
Indication: ?torsion
MOA: exploration and surgical fixation of BOTH
sides to scrotum; may need orcidectomy
Complications
Recurrence on other
testes (fix both at surgery)
N+V