Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males

Abstract

ObjectiveTo evaluate the features of testicular torsion presenting with acute abdominal pain and to raise awareness of testicular torsion with specific symptoms.MethodsFrom October 2005 to June 2016, nine patients with testicular torsion who presented with isolated acute abdominal pain rather than scrotal pain as their primary symptom were retrospectively reviewed. Data, including the age of patients, season at admission, initial medical history, external genital examination, emergency ultrasound findings, operative findings, duration of abdominal pain, complications, and follow-up results, were collected.ResultsThe average age of patients was 14 years (range 10–17 years). Seven patients whose genitals were not initially examined externally were misdiagnosed as having ordinary abdominal diseases. Surgical exploration revealed that all the involved testes necrotized, and orchidectomy was performed. In the other two patients, scrotal and testicular abnormalities were detected immediately on admission, and emergency surgical exploration determined that the involved testis remained vital, so orchiopexy was performed. The mean duration from symptom onset to diagnosis was 4 h (3–5 h) in the orchiopexy group and 37 h (18–72 h) in the orchidectomy group. Six patients were psychologically affected during postoperative follow-up. Neither recurrence of testicular torsion nor testicular atrophy was recorded.ConclusionAcute abdominal pain can be the initial and sole symptom of testicular torsion in young males. Physicians should pay close attention to the specific clinical presentation of testicular torsion.

Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

“…The delayed presentation of our patients is evident in the mean 4 hours period before presentation. Wang et al also reported a mean period of 4 hours, between the onset of symptoms and presentation to the hospital, for the patients whose testes were salvaged and 37 hours for patients whose testes could not be salvaged [13]. The optimal time frame is less than 6 hours after onset of symptoms [2].…”

Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency

“…Usually, TT can be diagnosed by an external genital examination and color Doppler ultrasound. However, these patients are often initially evaluated by non-urologists who know little about TT; therefore, the diagnosis is delayed or mistaken [5]. TITT may especially be misdiagnosed as acute scrotitis or epididymo-orchitis and traumatic scrotal hematoma [2].…”

“…The clinical data including the patient’s age, medical history, scrotal trauma type, mean duration of symptoms before hospitalization, type of pain, external genital examination findings, emergency ultrasound manifestations, operative findings, complications, and follow-up information were collected. Depending upon the testicular blood flow after detorsion, either orchiopexy or orchidectomy was performed [5]; patients with contralateral testes routinely underwent an orchiopexy.…”

Let's not Clinically Miss Testicular Torsion in Patients Presenting with Lower Abdominal Pain and Vomiting

“…Such atypical presentation is reported in literature, and nearly 12% of children can present only with abdominal pain. [ 3 ] The exact pathophysiology of testicular torsion presenting with abdominal pain is not clear. It could be related to a common innervation between the scrotum (L1 in the anterior part and S2 and S3 in its posterior part), testis, and abdominal organs.…”

“…The cause could just be mechanical when the twisted spermatic cord or the tensed cremaster muscle pulls and stimulates the peritoneum. [ 3 ] The risk of testicular loss is very high if there is delay in the initial diagnosis of testicular torsion. [ 4 ] The loss of one testis may not significantly impact later paternity or erectile function, but it surely impacts the child's body image and self-confidence.…”