Testicular torsion
| Testicular torsion | |
|---|---|
 |
|
| 1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens) | |
| Classification and external resources | |
| Specialty | Urology |
| ICD-10 | N44 |
| ICD-9-CM | 608.2 |
| OMIM | 187400 |
| DiseasesDB | 12984 |
| MedlinePlus | 000517 |
| eMedicine | med/2780 |
| MeSH | D013086 |
Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the testicle's blood supply, a condition called ischemia. The principal symptom is rapid onset of testicular pain. The most common underlying cause is a congenital malformation known as a "bell-clapper deformity" wherein the testis is inadequately affixed to the scrotum allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels.
The diagnosis should usually be made on the presenting signs and symptoms and an urgent ultrasound should only be done when the diagnosis is unclear. Irreversible ischemia begins around six hours after onset and emergency diagnosis and treatment is required within this time to minimize the risk of testicle loss.
It is most common just after birth and during puberty. It occurs in about 1 in 4,000 to 1 per 25,000 males per year before 25 years of age.
Testicular torsion usually presents with sudden, severe, testicular pain (in groin and lower abdomen) and tenderness. There is often associated nausea and vomiting. The testis may be higher than its normal position. Mild pyrexia and redness of overlying area may be found.
Some of the symptoms are similar to epididymitis though epididymitis may be characterized by discoloration and swelling of the testis, often with fever, while the cremasteric reflex is usually present. Testicular torsion, or more probably impending testicular infarction, can also produce a low-grade fever. There is often an absent or decreased cremasteric reflex.
A larger testicle either due to normal variation or a tumor increases the risk of torsion.
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Wikipedia