Delayed presentation of acute scrotum: a rare age for torsion

Abstract

An active and otherwise healthy, 59-year-old male presented to a small, community emergency department (ED) on Christmas Eve with complaints of scrotal swelling and testicular pain following a round of golf. Upon arrival that afternoon to the ED and following assessment, a scrotal ultrasound revealed absence of blood flow to the left testicle, consistent with testicular torsion. Manual detorsion by the staff ED physician proved unsuccessful, and unfortunately (due to the holiday) no urologist was on-call at this facility. Consequently, the patient was transferred to a larger regional medical center with urologic coverage. Further examination demonstrated a swollen, tender, erythematous left hemi-scrotum without evidence of infection. Immediate surgical exploration confirmed 540°t esticular torsion and an ischemic, necrotic testicle (Fig. 1). The patient underwent a left orchiectomy followed by a right orchidopexy. Pathologic examination revealed hemorrhagic infarction of the left testicle (Fig. 2). The patient was discharged on Christmas Day without sequelae.This case represents an atypical presentation of acute testicular torsion. Acute testicular torsion is rare in the sixth decade of life and has only been cited in a case report on one prior occasion [1]. This appearance of torsion eclipses the classic bimodal distribution of peak incidence

A 40-year-old man with testicular torsion and large bilateral spermatoceles

“…2,3 Although spermatic cord torsion can occur at any age, there are few reports of testicular torsion in older individuals. 4,5 Moreover, because of the rare incidence of torsion among the elderly, lack of clinical suspicion may lead to delayed or missed diagnosis. 6 Herein, we present the case of a 40-year-old man with testicular torsion accompanied by spermatocele (epididymal cyst).…”

An Unusual Cause of Acute Scrotum in a 65-Year-Old Man

“…Kessler and Bauml described testicular torsion as a bimodal age pattern in which the first peak is between age 1 to 2 and another peak is in the adolescent years where 85% of all cases occur between age of 12 and 18 (2,3). Kessler and Bauml described testicular torsion as a bimodal age pattern in which the first peak is between age 1 to 2 and another peak is in the adolescent years where 85% of all cases occur between age of 12 and 18 (2,3).…”

Missed Spermatic Cord Torsion in an Old Man

“…The salvage rate of an affected testis largely depends on the duration and degree of torsion [2,3]. Although SCT can be seen at any age, in fact, there have been few reports of older men with SCT [4,5]. Because of its rarity in the older age group, the lack of suspicion for SCT may lead to delayed diagnosis or misdiagnosis.…”