Post-traumatic testicular torsion

Case contributed by Dr Yair Glick

Presentation

Got hit in left scrotum by football

Patient Data

Age: 15 years
Gender: Male
Ultrasound

Hypoechoic left testicle with no internal flow. Head of epididymis markedly enlarged and inhomogeneous. Small amount of septated fluid adjacent to it, most probably ageing blood. Entire epididymis with no internal flow. Absent flow in testicular cord. Ipsilateral scrotum thickened and hyperaemic.
Right testicle appears normal.

Photo

Necrotic left testicle prior to excision.

Case Discussion

Patient took a soccer ball to the left scrotum. Pain was "tolerable" for several days. Pain increased on the day prior to presentation. On manual examination, there was erythema, swelling, thickening, and induration of left scrotum. Left testicle could not be separated from its epididymis.

Ultrasonic examination with Doppler interrogation demonstrated a hypoechoic left testicle with no internal flow. Head of epididymis was thickened and inhomogeneous and entire epididymis showed no internal flow. Right testicle appeared completely normal.

At surgery, left testicle was completely necrotic. Cord had torsed 540 degrees. Testicle was promptly excised and contralateral orchiopexy was performed. Of note, what had appeared at ultrasound as a thickened head of epididymis was actually part of the torsed testicular cord, or perhaps a conglomeration of both epididymal head and cord.

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Case information

rID: 52246
Case created: 29th Mar 2017
Last edited: 12th Nov 2017
System: Urogenital
Inclusion in quiz mode: Included

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