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 2024/10/14 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