Torsion of Testis

• surgical emergency

• torsion must be released within few hours or testis will necrose

• infants get extravaginal torsion

• 'bell-clapper' testis in adults leads to intravaginal torsion

History

• sudden onset severe testicular pain
• poorly localised central abdominal ain
• vomiting

Examination

• affected testis
  • tender
  • swollen
  • drawn up into neck of scrotum with thickened cord
• overlying scrotal skin
  • at later stage becomes red and oedematous

Differential

• acute epidymitis
• torsion of epididymal appendage (hydatid of Morgagni)

Treatment

• surgical exploration
  • untwist
  • if fails to gain colour remove
  • remaining or both testes secured to prevent recurrence

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