Segmental Testicular Infarction Associated to Torsion: First Case Report in Childhood

Abstract

Testicular torsion in children is not uncommon emergency problem which occur due to twist in the spermatic cord leading to ischemia or infarction to testicle. Hemorrhagic infarction can occur following testicular torsion is globally; however, in extremely rare situation, such infarction can be segmental. Segmental testicular infarction (STI) was reported in an infant due to epididymitis and a newborn with STI in 1 testicle with complete infarction in the contralateral testicle due to birth trauma. To best of our knowledge, our case of STI in a child associated with testicular torsion is the first described in the literature. UROLOGY 00: 1−3, 2020.

Role of ultrasound in manual detorsion for testicular torsion

“…Perfusion of the testis, after manual detorsion, may be influenced by the condition within the testis, such as edema or testicular necrosis. 15,25,26 Moreover, testicular arteries are divided into two, three, or four branches at a variable distance in the spermatic cord from the testis. 25,27 Therefore, all cases with spermatic cord twist might not involve all these branches, which could influence the vascular flow within the affected testis.…”

“…15,25,26 Moreover, testicular arteries are divided into two, three, or four branches at a variable distance in the spermatic cord from the testis. 25,27 Therefore, all cases with spermatic cord twist might not involve all these branches, which could influence the vascular flow within the affected testis. These branches travel downwards along the medial surface of the testis, and then turn up and travel along the lateral surface toward the upper pole; the branches extend from the upper pole toward the mediastinum testis along the seminiferous tubule.…”

“…27 Therefore, owing to arterial occlusion by thrombus or edematous change occurring in some of these branches, the terminal area may not have sufficient perfusion after manual detorsion. 25 As a result, the affected testis, even after successful manual detorsion, could show hypoperfusion.…”

“…Upon detorsion, the testicular arterial flow is established and perfusion of the testicular surface might recover, regardless of the recovery of perfusion in the terminal area. 25 In addition, Hosokawa et al, using an ultrasound, reported a diagnostic accuracy of 78.6% in detecting the direction of testicular rotation, where the incidence of outer rotation was 50%. 9 Therefore, the direction of rotation may be misdiagnosed.…”

An Unusual Case of Testicular Seminoma Mimicking Segmental Testicular Infarction

“…The etiology of STI is uncertain, but arterial vascular obstruction owing to venous thrombosis is believed to be one of the probable causes. Similar to the seminoma, STI commonly occurs between the third and fourth decade of life [2]. The most common symptom of STI is acute testicular pain.…”