We reported a case of torsion of the undescended testis in a 9monthold boy which was diagnosed with 99mtc testicular scintigraphy. Four separate retrospective studies have shown that an absent or decreased cremasteric reflex is the most sensitive physical examination sign for diagnosing testicular torsion 10. Testicular torsion is a surgical emergency and should be operated on immediately once a diagnosis is made. Downloaded from the american family physician website at. Where there is a suspicion of testicular tumour preceding mass or chronic history 24. One third of patients present with a palpable blue dot discoloration on the scrotum. Occasionally, these attachments do not exist and the testicle can twist. The testicle may be higher than usual in the scrotum and vomiting may occur. Pdf torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians. Key points testicles should be palpable in the scrotum by 6 months of age. Torsion of undescended testis but no age is e xempted, as was seen in our patient who was three years old. If testicular torsion goes on for more than a few hours, it can permanently damage the testicle, and a damaged testicle must.
Importantly, the authors point out that testicular torsion cases are a common cause of malpractice lawsuits. Sep 21, 20 what are the symptoms of testicular torsion. Embryology of the testis medical university of south. Exploration of torsion of testis hillingdon hospitals nhs. It causes occlusion of testicular blood vessels and, unless prompt action is taken, rapidly leads to ischaemia, resulting in loss of the testis germ cells are the most susceptible cell line to ischaemia.
Clinical history is useful but often can overlap for both entities at presentation. Negative for germ cell neoplasia in situ intratubular germ cell neoplasia. A discussion of the most important and common conditions that cause acute scrotal pain or swelling follows. Conservative therapy is the first choice for relief from symptoms. Careful examinations of severe damage to the seminiferous epithelium after repair of unilateral torsion have never shown a significant contralateral effect on spermatogenesis 20 or even on a number of other. Excision of recurrent appendix testis torsion sciencedirect. Diagnosis and management of testicular torsion, torsion of. Embryology of the testis parks and jameson endocrinology 1463. Oct 20, 2016 torsion of testicular appendages can result in the clinical presentation of acute scrotum. Testicular torsion is a surgical emergencyusually done within 6 hours of onset of symptoms, there will be a 90100% change that the testicle can be saved surgery. Click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Full text distinguishing testicular torsion from torsion of. Senior surgicalregistrar, themiddlesex hospital, london, w.
Testis with diffuse intratubular hemorrhage and focal desquamation of germ cells. Torsion of the appendix testis also causes pain and swelling of the scrotum. Torsion of a large appendix testis misdiagnosed as pyocele. The extent of torsion is variable, ranging from 90 to 720 degrees, with complete torsion occurring with twisting of 360 degrees or greater. Full text full text is available as a scanned copy of the original print version. The appendix testis was first descrived by morgagni 2,3 in 1761. The patient should be consented for reduction of torsion, bilateral. As the most common cause of scrotal pain in children, torsion of the appendix testis can present with clinical features similar to testicular torsion, such as severe acute scrotal pain with. To report our experience and present the largest series of testicular torsion cases in the inguinal canal.
Intraoperative findings revealed torsion of the appendix testis in an inguinal cryptorchid testicle. We present a case of torsion of undescended testis in a 44yearold man, who had progressive left inguinal pain for 2 days and in whom surgical exploration showed a twisted gangrenous testis. Partial testicular torsion and torsiondetorsion syndrome. Our patient had a normal lie of the opposite testis. Scribd is the worlds largest social reading and publishing site. Another supportive finding is the blue dot sign, which occurs in a.
Torsion and detorsion in gastropods pdf download download 53075fed5d torsion,of,the,normal,adnexa,in,early,pregnancy,and,laparoscopic,detorsion,pages. Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum naoyuki fujita,1 mitsuhiro tambo,1 takatsugu okegawa,1 eiji. Exploration of torsion of testis this information sheet has been written to provide parents and older children with an explanation of the care and management of torsion of testis. The testicle has attachments that hold it in place in the scrotum.
Testicular torsion is a painful urologic emergency caused by twisting of the spermatic cord causing compromise of the blood supply to the affected testis fig. Testicular torsion is a twisting of the spermatic cord and its contents and is a. The inflammatory cells with testicular torsion are frequently lymphohistiocytic instead of the mixed inflammatory cells of a polyarteritis nodosa. Two such appendages are the appendix testis, a remnant of the paramesonephric mullerian duct, and the appendix epididymis, a remnant of the mesonephric wolffian duct.
Jul, 2016 torsion of the testis may more accurately be called torsion of the spermatic cord. Scintigraphic evaluation of testicular torsion and. Testicular torsion tt is a common cause of acute scrotal pain in young men and accounts for as many as 26% of cases of acute scrotum. Manual detorsion should be attempted if surgery is not an immediate. Full text distinguishing testicular torsion from torsion. Torsion of the testes is a true urologic emergency, since it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. Diagnostic errors are madesimplybecause practitioners and surgeons are not familiar. Torsion of undescended testis university of toronto tspace. Testicular torsion occurs when the spermatic cord from which the testicle is suspended twists, cutting off the blood supply to the testicle.
The patient presented 5 days post initiation of acute scrotal and unfortunately the testis was not viable at that late time. Torsion of the appendix testis in an undescended testicle. Testicular torsion can happen to boys and men of any age, but is most common in 12 to 18yearolds. Incidence of testicular torsion has a bimodal age distribution. Intermittent testicular torsion presents with recurrent episodes of severe unilateral testicular pain with resolution of.
This type of testicular torsion is called extravaginal torsion and can occur pre or postnatally. Torsion of the spermatic cord, causing strangulations of the. Testicular torsion, the spontaneous twisting of the spermatic cord leading to compromise of testicular blood flow, occurs in 14000 males. Torsion of the appendix testis does not usually require surgery. Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum naoyuki fujita,1 mitsuhiro tambo,1 takatsugu okegawa,1 eiji higashihara,2 kikuo nutahara1 1department of urology, 2department of autosomal dominant polycystic kidney disease adpkd research, kyorin university school of medicine, mitaka, tokyo purpose. Torsion of the appendix testis is not an uncommon cause of acute hemiscrotum. The appendix of testis can, occasionally, undergo torsion i. Testicular torsion right testis ultrasound of the testes demonstrates the right testis to be enlarged, heterogeneous in echotexture, and without evidence of any blood flow. Therefore normal lie of the opposite testis should not rule out torsion. The patient should be kept fasted and a surgical referral should be made without delay.
On examination testis was swollen, tender and cremasteric reflex was absent. Reduction of torsion of testis and fixation springerlink. Embryology of the testis the medical university of south. The scan showed diffuse increased activity in the location of the undescended testis and no photopenic area was visible. Color doppler sonography cds is the imaging modality of choice for evaluation of the acute scrotum. If symptoms are localized to the upper pole of the testis, testicular appendiceal torsion is likely. Fibrinoid vascular necrosis can be seen in both entities.
It also may occur during sports or physical exercise. A 26yearold male with a 14year history of left intermittent. This document was amended in july 2016 to reflect literature that. If testicular torsion goes on for more than a few hours, it can permanently damage the testicle, and a damaged testicle must be removed.
Another supportive finding is the blue dot sign, which occurs in a minority of. Treatment for torsion of the appendix testis includes nonsteroidal antiinflammatory drugs and restricted activity. Testicular torsion requires immediate surgery to save the testicle. Acute testicular pain, often with abdominal pain and sometimes vomiting has a high predictive value for testicular torsion. Importantly, the authors point out that testicular torsion cases are a common cause of malpractice. The most common symptom in children is sudden, severe testicular pain.
Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3. Fulltext pdf usefulness of evaluating testicular heterogeneity in cases of testicular torsion. The most significant diagnosis to consider in a patient presenting with acute scrotal pain is that of torsion of the testis. Torsion and detorsion in gastropods pdf download download. Torsion of the spermatic cord, causing strangulations of. Torsion of the appendix testis is a common cause of acute scrotal pain in children 1,2. The left testis tends to be more commonly affected.
Pdf torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for. Understanding the testis there are two testis located in the scrotum. While the history and physical examination may spur the likely diagnosis of the acute scrotum to be testis torsion, a failure to make the diagnosis commonly. Distinguishing testicular torsion from torsion of the. Torsion of the spermatic cord results in impaired blood flow to the ipsilateral testis and if left untreated results in testicular necrosis and subsequent infertility. V arious factors have been reported to precipitate torsion,2,3 but interestingly, none. Get a printable copy pdf file of the complete article 1. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Testicular torsion is a medical emergency in which the spermatic cord along with the spermatic artery inside it undergo torsion.
Testicular torsion diagnosis and treatment online medical. A flexible tube known as the spermatic cord connects each of the testis with the abdomen. Eightynine of these suffered from torsion, either of. The patient should be consented for reduction of torsion, bilateral testicular fixation, orchidectomy if needed, and insertion of testicular prosthesis if needed. Torsion of the appendix testis has never been reported in the newborn, the youngest previously recorded case being at 11 months of age. The necrotic appendix was excised and cryptorchidism corrected. Torsion can occur at any time, while sitting or standing, or may awaken an individual from sleep. Torsion of undescended testis located within the inguinal canal is a rare entity, represents a surgical emergency, and must be dealt with immediately. Testicular torsion 080615 ucsf department of urology. Four separate retrospective studies have shown that an absent or decreased cremasteric. V arious factors have been reported to precipitate torsion,2,3 but interestingly, none was found in our patient. A positive or normal cremasteric reflex is seen when the. Torsion of the appendix testis in an undescended testis is an uncommon condition.
Testicular torsion is a twisting of the spermatic cord and its contents and. The hallmark of testicular torsion is sudden, severe, onesided testicular pain. The spermatic cord was untwisted and no associated hernia sac was identified. Eightynine of these suffered from torsion, either of the testis or appendix testis. Exploration for suspected torsion of the testis pdf.
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