Dr.Shobika,Dr.Jayakumar,Dr.Praveena,Dr.Naveen(pediatric surgery)
AIMS KOCHI
Seventeen year old male child who is developmentally normal, immunized upto age,presented with complaints of sudden onset of left sided testicular pain since 3 days.
No h/o fever,urinary symptoms,abdominal pain,loose stools,trauma
Past history-No similar illness in past
Growth parameters were normal.
Investigations done showed CRP-72.64mg/dl,TLC-19.3ku/ml,N-75.3%,L-15.4%,E-0.6%,
Preop serology done were negative.
Differentials
Acute epididymo orchitis
Torsion testicle
Torsion of the appendix of epidiys
Strangulated hernia
Testicular trauma
USG scrotum with doppler done showed left testes appears altered echotexture with areas of hypoechoic areas within.
Left spermatic cord shows whirlpool sign-suspicious of left torsion testes.
The child was immediately taken up for scrotal exploration and orchidectomy on a emergency basis.
Intraoperative findings:left testis with epididymis was torsioned and gangrenous.Derotation done and testis covered with warm saline soaked gauge.100%oxygen administered.No improvement in color noted.Left low orchidectomy done.Right side orchidopexy done.
Post operative period were uneventful.
The child was discharged wiith 5 days of antibiotics and supportives.
Definition:
Testicular torsion is the most important and potentially serious of the acute processes affecting the scrotal contents because it may result in the loss of function of the testicle.
Clinical presentation:
Abrupt onset of severe testicular or scrotal pain, usually of less than 4hours’ duration
On physical examination, the scrotum may be edematous, indurated and erythematous and the affected testis usually is tender, swollen, and slightly elevated because of shortening of the cord from twisting
TWIST score for testicular torsion :
●Nausea or vomiting: 1 point
●Testicular swelling: 2 points
●Hard testis on palpation: 2 points
●High-riding testis: 1 point
●Absent cremasteric reflex: 1 point
A score ≥5 diagnosed testicular torsion with sensitivity 76 percent, specificity 100 percent, and positive predictive value 100 percent (prevalence of torsion, 15 percent).
A score ≤2 excluded testicular torsion with a sensitivity 100 percent, a specificity 82 percent, and a negative predictive value 100 percent
The treatment for a torsed testicle that remains viable involves surgical detorsion and fixation (orchiopexy). Orchiectomy is performed if the testicle is nonviable. The viability of a torsed testicle is dependent upon the duration and completeness of torsion.
Detorsion within 4 to 6 hours: 97 to 100 percent viability
●Detorsion after 12 hours: 20 to 61 percent viability
●Detorsion after 24 hours: 0 to 24 percent viability
Carry home message:
Never forget to examine external genitalia in male children
Advise orchidectomy of the undescended or dysplasitic testicle and orchiopexy of normal testicle
Examine clinically with in no time all testicular pain to rule out torsion and do Doppler if there is clinical suspicion at the earliest and referral may be made at the earliest to the paediatric surgeon
Advise:
Not to traumatise the testicle and to immunise against Mumps for all male children