EMERGENCIES ALL SHOULD KNOW:TESTICULAR TORSION

TESTICULAR TORSION

Sudden testicular pain could be because of the twisting of the spermatic cord.

 The spermatic cord carries the blood vessels to the testis. The twisting can knock off the blood flow to the testis and render the testis blood less( ischemic).This results in acute pain. The patient becomes incapacitated.

Sometimes the torsion is characteristically intermittent ; with episodes of  pain coming and going.

The necessity of diagnosing this condition early is very important as with every passing hour the testis becomes more and more devitalized.

In the initial few hours; we can resort to restoration of the rotated testis preferably under sedation with the help of anaesthesiologist ( either manually or by scrotal exploration).

The basic reason for the torsion is supposed to be inadequate fixation of the testis to the scrotal wall( clapper bell deformity).So whenever a person strains with this deformity, the spermatic cord tends to rotate onto itself leading to the ischemia and pain.

If the ischemia persists for a longer time:

1)either   because of the delay in patient reporting to health care professionals

2) or wrong or delay in diagnosis

Then the devitalisation of the testis will happen progressively. As the deformity happens in bilateral testes; the recommended  strategy is bilateral orchiopexy ( to prevent the rotation again in future by fixing the testis to the scrotal wall).

Testicular torsion is a surgical emergency that requires immediate intervention to restore the flow of blood. If treated either manually or surgically within six hours, there is a high chance (approx. 90%) of preserving the testicle. At 12 hours the rate decreases to 50%; at 24 hours it drops to 10%, and after 24 hours the rate of preservation approaches 0.

Clinically the patient has typically severe pain with no fever. He will not have any urinary symptoms( this history will exclude epididymo-orchitis( infective aetiology): a condition which mimics the torsion).There is antecedent trauma or straining leading to acute onset of the pain.

The scrotum is swollen and very tender to touch.The testis is usually high lying with axis horizontal.

We on a slightest suspicion seek for USG Doppler scrotum to know the vascularity of the testis or any compromise of it.

If any ambiguity is present we usually go for Testicular  scan .The radio nuclear scan shows the void of any activity in the center of the testis because of the  lack of vascularity. This almost always confirms the diagnosis.
Torsion is most frequent among adolescents with about 65% of cases presenting between 12 – 18 years of age.but it can occur at any age, including infancy.

Torsion of testicular appendix is a  type of torsion and is the most common cause of acute scrotal pain in boys ages 7–14. Its appearance is similar to that of testicular torsion but the onset of pain is more gradual.Unlike other torsions,the cremasteric reflex is still active. Typical treatment involves the use of over-the-counter analgesics and the condition resolves within 2–3 days.