Definition

This is when the spermatic cord (contains the vas deferens, lymphatic vessels, testicular artery, cremasteric artery, panpiniform plexus (veins), nerve to cremaster, testicular nerves) to a testicle twists therefore cutting off the blood supply to the testicle. This is due to a mechanical twisting process which can lead to testicular death. It is a MEDICAL EMERGENCY.

Epidemiology

Risk Factors

• Bell-clapper deformity (this is where the testicle has formed with no attachment to its surrounding scrotal walls and so is free floating within the tunica vaginalis – the serous sac surrounding the testicle)
• Large size – either normal variation or the presence of a tumour
• Sudden change in temperature from hot to cold causing sudden scrotal contraction which can trap the testicle in a rotated position
• An undescended testis
• Previous testicular pain

Differential Diagnosis

• Epididymitis (main differential)
• Epididymo-orchitis
• Scrotal oedema
• Incarcerated inguinal hernia

Presentation

• Acute onset of diffuse pain – can be in the scrotum, groin, lower abdomen or the inguinal region.
• Swollen testis
• Testicular tenderness
• Fever
• Nausea
• Vomiting

Investigations

• Doppler Ultrasound Scan can be done to look at the flow of testicular blood – this helps to rule out epididymitis where the flow will be present. In torsion, there will be absent blood flow.
• Cremasteric reflexshould be absent in true torsion but may only be diminished so this is not an accurate investigation.
• Surgical exploration is mandatory unless torsion can be excluded.

Treatment

• Surgical emergency– immediate intervention required to detort the testis.

Prognosis

• If treated within 6 hours – 90% chance of survival of the testicle surviving; 12 hours – 50%; 24 hours – 10%; >24 hours – 0%.

- See more at: http://almostadoctor.co.uk/content/systems/genitourinary-system/testicular-torsion#sthash.yVZF0tFY.dpuf