testicular torsion

Introduction

see scrotal pain/mass

Pathology

• occurs when the testes twist on the spermatic cord
• testicular ischemia

Clinical manifestations

• acute unilateral several scrotal pain with swelling
• overlying scrotal skin may be erythematous & warm
• presents acutely with nausea & vomiting
• high-riding testicle, transversely oriented
• pain worsening with manual elevation*
• ipsilateral absent cremasteric reflex

* contrast with epididymitis

Diagnostic procedures

• doppler ultrasonography to assess blood flow
  • not necessary for patients with supportive history & unequivocal physical examination findings (ipsilateral absence of cremasteric reflex)
  • surgery should not be delayed to obtain imaging

Management

• surgical emergency
  • reduction of testicular torsion, orchidopexy
  • surgical reduction within 6 hours

More general terms

• scrotal pain/mass (testicular pain, testicular torsion)

Additional terms

• testis