(A&E)

Overview

• Sudden twisting of the spermatic cord → results in venous outflow obstruction from the testicle, progressing to arterial occlusion and testicular infarction if not corrected
• Surgical EMERGENCY
• Peak incidence in first 30 days of life and during puberty (10-18 yrs old)
• Most common cause → bell clapper deformity (horizontal lie of the testes) and cryptorchidism (undescended testes)
• Different Types → Intravaginal Torsion (most common - twisting within the tunica vaginalis) & Extravaginal Torsion (usually in neonates)
• Irreversible damage occurs after 6-12 hours of torsion

Making Diagnosis

Clinical Features:

• Sudden onset severe unilateral Testicular Pain
• Swollen & Tender scrotum
• High-Riding Testicle → affected testicle may appear higher than the unaffected testicle
• Absent Cremasteric Reflex (DIAGNOSTIC FOR TESTICULAR TORSION?) → elevation of the testicle and scrotum in response to stroking of the ipsilateral inner thigh
• Negative Prehn Sign → no pain relief on elevation of testes (distinguishes between testicular torsion and epididymitis)
• Nausea & Vomiting