A bell clapper deformity is a predisposing factor in testicular torsion in which the tunica vaginalis has an abnormally high attachment to the spermatic cord, leaving the testis free to rotate. Bell clapper deformity predisposes to intravaginal torsion of the testis.
It is best defined as the complete investment of the testis, epididymis and a portion of the spermatic cord by the tunica vaginalis. It has a reported occurrence of 5-16% and is seen bilaterality in 66-100% 3.
History and etymology
The term was first reported in the literature in1932 by Muschat who described the testes “hanging freely in the vaginal sac like a clapper in a bell” 4.
- 1. Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. Urology. 1994;44 (1): 114-6. Pubmed citation
- 2. Aso C, Enríquez G, Fité M et-al. Gray-scale and color Doppler sonography of scrotal disorders in children: an update. Radiographics. 2005;25 (5): 1197-214. doi:10.1148/rg.255045109 - Pubmed citation
- 3. Taghavi K, Dumble C, Hutson JM, Mushtaq I, Mirjalili SA. The bell-clapper deformity of the testis: The definitive pathological anatomy. (2020) Journal of pediatric surgery. doi:10.1016/j.jpedsurg.2020.06.023 - Pubmed
- 4. Muschat M. The pathological anatomy of testicular torsion: explanation of its mechanism. Surgery, Gynecology & Obstetrics. 1932;54:758-63.