Although not very common , torsion of the testis occurs particularly in the young and at times even in infants. The condition is due to the axial rotation of spermatic cord, probably because of an abnormal high position of the tunica vaginalis around the end of spermatic cord allowing the testicle to twist freely within the compartment. Relatively longer mesorchium is also a cause for this.
Although torsion can happen even during sleep it is frequently associated with physical activity like playing, swinging etc. More often the symptoms include painful swelling of the hemiscrotum, pain in the inguinal region and hypogastric area, associated with nausea, vomiting and minimal raise of temperature and pulse rate.
Physical examination will reveal presence of swelling of the scrotum and edema of the scrotum. The testis is uniformly enlarged along with the epididymis. The testis is drawn upwards closer to the external rising. Compared to the other testis this is pulled up and even the patient may be able to appreciate the difference. If one does not suspect this condition on clinical grounds, it is usually mistaken for epididymo-orchitis due to trauma, filaria etc and in appropriate treatment is given. The only way the diagnosis can be established is by doing the technetium isotope scan if it is readily available and expertise is available to interpret the same. But it is prudent to avoid loss of time if this diagnosis is clinically strong.
Procrastination and delaying the exploration will result in irreversible damage and gangrene of the testis and may require orchidectomy instead of orchidopexy. At surgery, through an inguino scrotal approach the tunica is opened, the cord is untwisted, the viability of testis checked and orchidopexy (fixing the testis ) is done. In order to prevent similar instance on the other testis, prophylactic orchidopexy on the unaffected side is usually indicated.
Torsion of testis is more likely to occur in those where the testis has not descended well into the scrotum. Whenever the scrotal sac is empty in one or both sides, and testis cannot be felt it would mean that the descent of testis has been arrested and it is lying in the abdomen or the groin. When torsion occurs in the testis that is lying in the inguinal area the two important signs are painful swelling in the inguinal region and absent testis in the side of the scrotum. Here prompt exploration and orchidopexy is indicated when the testis is still viable. Intra-abdominal undescended testis can also undergo torsion and cause abdominal pain in the mid or lower abdomen, with nausea and vomiting, with some local tenderness and guarding at times. Diagnosis of torsion of the undescended abdominal testis has to be remembered when the scrotal sac is empty on that side. Here again a surgical consultation should be promptly obtained.
|Warning: *Acute on set of scrotal pain must be examined for torsion routinely. |
Where facilities exist, Isotope scanning may be of help in establishing the diagnosis. Exploration on clinical suspicion is justified under the circumstances.
Elevated testis on one side which is painful and tender deserves examination for possible torsion of testis. Early appreciation of the problem and prompt exploration will give satisfactory results.Bilateral orchidopexy is the operation of choice in situation like this (fixing testis on both sides).
*Undescended testis is more likely to undergo torsion
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