RT Book, Section
A1 Breland, David J.
A1 Rubinstein, Mark L.
A2 Rudolph, Colin D.
A2 Rudolph, Abraham M.
A2 Lister, George E.
A2 First, Lewis R.
A2 Gershon, Anne A.
SR Print(0)
ID 6737480
T1 Chapter 75. Scrotal Masses
T2 Rudolph's Pediatrics, 22e
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-149723-7
LK accesspediatrics.mhmedical.com/content.aspx?aid=6737480
RD 2024/04/19
AB Testicular  torsion  is  a  surgical  emergency,  and  clinicians  caring  for  adolescent  males  must  have  a  high  index  of  suspicion  given  the  short  window  for  salvage  of  the  testicle.  Common  presentation  includes  abrupt  onset  of  severe  scrotal  pain  with  associated  nausea,  vomiting,  fever,  and  abdominal  pain.1-3  Symptomatic  males  may  describe  prior  transient  episodes  of  scrotal  pain  consistent  with  intermittent  torsion/detorsion.1  The  exact  etiology  of  torsion  is  unknown.  However,  a  well-described  anatomical  abnormality  called  the  “bell  clapper”  deformity  can  predispose  to  testicular  torsion  (see  Figure  75-1).  In  this  deformity,  the  tunica  vaginalis  completely  surrounds  the  testicle,  including  the  posterior  aspect,  and  the  absence  of  the  normal  posterior  anchoring  allows  the  testicle  to  twist  freely.  On  physical  examination,  if  the  adolescent  presents  early,  the  testicle  may  have  a  horizontal  lie  with  minimal  swelling.1-3  Typically,  the  adolescent  presents  later,  and  the  scrotum  is  swollen,  tender,  erythematous,  and  often  difficult  to  examine.1-4  The  cremasteric  reflex  is  nearly  always  absent.1-3  Diagnosis  can  be  made  on  physical  examination  or  with  the  assistance  of  color  Doppler  ultrasound,  which  has  a  sensitivity  of  89%  to  100%  and  a  specificity  of  77%  to  100%.2,4  Time  is  of  the  essence  because  testicular  viability  declines  to  zero  after  24  hours.2-4  Treatment  involves  prompt  surgical  exploration  and  detorsion.  Given  the  high  incidence  of  retorsion,  as  well  as  torsion  of  the  contralateral  testis,  once  detorsed,  the  affected  testis  and  the  contralateral  testis  are  fixed  to  the  scrotum  in  a  procedure  called  scrotal  orchiopexy.2,3