Testicular torsion is the twisting of the testicles and the spermatic cord (the structure extending from the groin to the testes that contains nerves, ducts, and blood vessels of the testis). The torsion causes decreased blood flow to the testes, resulting in the depletion of oxygen and nutrients to the testicles. This is a painful problem that usually occurs in boys age 10 and older. While it generally occurs in adolescent boys, it may rarely also occur during foetal development or shortly after a baby is born.
In preadolescent and adolescent boys, torsion occurs primarily from the incomplete attachment of the testes within the scrotum. This permits the testes to be more movable, allowing them to twist. The symptoms of testicular torsion may involve one or both of the testes. Although each child may experience symptoms differently, the most common symptoms of testicular torsion are Scrotal (involving the scrotum) pain or tenderness, swelling, bruising, firmness, redness.
Testicular torsion is usually diagnosed by physical examination and a complete medical history. If it is readily available an ultrasound colour doppler is done, to assess blood flow to the testicles. It is imperative to make a prompt diagnosis because prolonged testicular torsion may cause irreversible damage to the testes. Other diagnostic tests may be included, but there is no test that can diagnose testicular torsion accurately all of the time and all the tests are not available all the time, so it is important that unnecessary time is not wasted on tests and prompt intervention done to.
Testicular torsion is an emergency condition and requires immediate surgical intervention. The severity of the torsion depends on if the testicle(s) is partially or completely twisted. The more twisted the testicle, the more urgent the intervention. To minimize long-term problems, intervention is to be done as soon as possible as delay in surgery can cause loss of the testis. Surgerywill help prevent torsion from occurring in the future and also fixes the opposite testicle.
10 year old boy had complaints of severe pain in scrotum for 2 days. He also had a lot swelling and redness in the scrotum. He was taken up for emergency surgery and was found to have torsion of the left testis (ie the testes twists over its blood supply) and the testis had become dead and so was removed and the right testis was fixed.
A 14 year old boy had complaints of redness, with swelling and pain in the scrotum for 4 hours and so was taken up for scrotal exploration on the suspicion of testicular torsion. He was found to have torsion of the right testis but on de-twisting the testicle became vascularized and so the testicle was fixed back in the scrotum and also the left testis was fixed.
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