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Testicular Torsion

Jonathan Green, MD, MSCI and Michael P. Hirsh, MD, FACS, FAAP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Twisting of testis and spermatic cord, resulting in acute ischemia and loss of testis if unrecognized:

    • Intravaginal torsion: occurs within tunica vaginalis, only involves testis and...

DIAGNOSIS

HISTORY

  • Acute onset of pain, often during period of inactivity

  • Onset of pain usually sudden but may start gradually with subsequent increase in severity

  • Nausea and vomiting are common:

    • Presenc...

TREATMENT

  • Manual reduction: best performed by experienced physician; may be successful, facilitated by lidocaine 1% (plain) injection at level of external ring:

    • Difficult to determine success of manu...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Postoperative visit at 1 to 2 weeks

  • Yearly visits until puberty may be needed to evaluate for atrophy.

DIET

Regular 

PATIENT EDUCATION

Possibility of...

REFERENCES

1
Van Glabeke E, Khairouni A, Larroquet M, et al. Acute scrotal pain in children: results of 543 surgical explorations. Pediatr Surg Int.  1999;15(5–6):353–357. [View Abstract on OvidM...

CODES

ICD10

  • N44.00 Torsion of testis, unspecified

  • N44.01 Extravaginal torsion of spermatic cord

  • N44.03 Torsion of appendix testis

  • N44.02 Intravaginal torsion of spermatic cord

  • N44.04 Torsion of appendix ep...

CLINICAL PEARLS

  • The diagnosis of testicular torsion is usually made by physical exam. Patients with suspected torsion should be taken to the OR without delay. If diagnosis is in question, a testicular...

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