EM · Testicular torsion

Testicular torsion

Also known as Spermatic cord torsion · Acute scrotum · Torsion of the testis

The testicular torsion — the twisting of the spermatic cord on its longitudinal axis that obstructs the venous return and then the arterial supply, producing the testicular ischaemia and necrosis; the quintessential time-critical surgical emergency of the acute scrotum with the salvage window of six hours. The clinical picture (the sudden severe unilateral testicular pain, the swelling, the high-riding testis, the absent cremasteric reflex, the horizontal lie, the nausea and vomiting), the diagnosis (the clinical diagnosis, the Doppler ultrasound if uncertain but never to delay surgery, the manual detorsion), the management (the urgent surgical exploration within six hours, the bilateral orchiopexy, the orchidectomy if necrosis). The differential (the epididymo-orchitis, the appendix testis torsion, the incarcerated hernia, the renal colic). ACEM-primary, globally tagged.