Testicular Torsion
Ultrasound is helpful to differentiate testicular torsion from other causes of acute scrotal pain and to identify testicular torsion promptly, ensuring the highest salvage rate. The severity of torsion of the testis can range from 180˚ to 720˚, but complete occlusion of blood flow does not occur until 450˚ of torsion. Transient or intermittent torsion with spontaneous resolution sometimes occurs. Venous congestion progresses to arterial occlusion, testicular ischemia, and infarction. The collateral blood flow is typically not adequate to provide viability to the testicle if the testicular artery is occluded.
Testicular torsion can be classified as extravaginal or intravaginal. Extravaginal torsion occurs in utero or perinatally before the testis is fixed, so the torsion occurs proximal to attachment of the tunica vaginalis, in the inguinal canal or just below it. This form of torsion is found exclusively in newborn infants. Intravaginal torsion is more common and is due to a bell-and-clapper deformity in which the tunica vaginalis has an abnormally high insertion on the spermatic cord and completely encircles the testis, leaving the testis free to rotate within the tunica vaginalis. The deformity is bilateral in most cases. Intravaginal torsion may also occur in testes that are retractile or are not fully descended. Blunt trauma, sudden forceful rotation of the body, or sudden exertion also predispose to testicular torsion.
Testicular torsion can be classified as extravaginal or intravaginal. Extravaginal torsion occurs in utero or perinatally before the testis is fixed, so the torsion occurs proximal to attachment of the tunica vaginalis, in the inguinal canal or just below it. This form of torsion is found exclusively in newborn infants. Intravaginal torsion is more common and is due to a bell-and-clapper deformity in which the tunica vaginalis has an abnormally high insertion on the spermatic cord and completely encircles the testis, leaving the testis free to rotate within the tunica vaginalis. The deformity is bilateral in most cases. Intravaginal torsion may also occur in testes that are retractile or are not fully descended. Blunt trauma, sudden forceful rotation of the body, or sudden exertion also predispose to testicular torsion.
Testicular Torsion
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