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Paediatrics: Testicular torsion

Testicular torsion must be excluded in a child with acute scrotal pain.

Testicular torsion

 

Testicular torsion must be excluded in a child with acute scrotal pain. The peak incidence occurs around 12yrs, but it can occur at any age.

   Congenital testicular torsion: rare perinatal event. Newborn infant has a hard, painless scrotal mass. Testis has invariably infarcted and exploration is not necessary, nor is fixation of the opposite testis. The pathology is torsion of the spermatic cord outside the tunica vaginalis.

 

   Torsion outside the perinatal period: the result of an abnormally mobile mesentery of the testis inside the tunica vaginalis. This anomaly is bilateral and allows the gonad to twist on its vascular pedicle.

 

Presentation

 

   Sudden onset severe scrotal pain, often associated with nausea and vomiting.

   Tender testis.

   Overlying scrotal skin may be reddened and oedematous.

 

Treatment

 

   Immediate scrotal exploration is mandatory to salvage the testis, which should then be fixed to prevent recurrence.

   The contralateral testis should also be fixed.

 

Differential diagnosis of acute scrotal pain

 

Testicular torsion

 

   Sudden onset pain, swelling, and nausea

 

   Testis is very tender, and may lie transversely in scrotum

 

   Scrotal skin may be red

 

Torted hydatid

 

   Gradual onset of less severe pain; no nausea

 

   Focal tenderness at upper pole of testis

 

   Torted hydatid may be visible through scrotal skin as a pea-sized blue/black swelling

 

Epididymo-orchitis

 

   Insidious onset of dysuria and fever

 

·  Usually associated with a urinary tract infection

 

   Red tender scrotum

 

Testicular trauma 

History obvious and there are signs of trauma/ haematocele 

Idiopathic scrotal oedema

 

   Child is well

 

   Scrotal skin is cellulitic but the testes are not tender

 

The condition settles spontaneously within a few days

 

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