🧵 Testicular Torsion

🔑 Key Learning

• Testicular torsion is a surgical emergency. Testicular salvage is possible within 4–6 hours; infarction risk rises sharply after.
• Classic triad: sudden testicular pain, high-riding testis, absent cremasteric reflex.
• Requires emergency surgical exploration without delay for imaging.

🧬 Pathophysiology

• Torsion of the spermatic cord compromises arterial blood supply to the testicle.
• Occurs within the tunica vaginalis, particularly in patients with a bell-clapper deformity.
• Leads to ischaemia and infarction if untreated.

⚠️ Risk Factors

• Age:
  • Neonates
  • Adolescents (peak 12–24 years)
• Bell-clapper deformity – horizontal lie, increased testicular mobility
• Undescended testes

👀 Clinical Features

🩺 Symptoms

• Sudden, severe unilateral testicular pain
• Pain may radiate to groin/lower abdomen
• Nausea and vomiting
• Possible history of intermittent torsion

🔎 Examination Findings

• High-riding, horizontally lying testis
• Absent cremasteric reflex
• Negative Prehn’s sign (no relief with elevation)

❓ Differentials

🧪 Investigations

• Diagnosis is clinical – do not delay surgery for imaging if torsion is suspected.
• USS may be used if torsion is unlikely or equivocal:
  • Reduced/absent testicular blood flow
  • Twisting of spermatic cord
  • Reactive hydrocele

💊 Management

• Emergency scrotal exploration in all suspected cases
• If testis is viable → Bilateral orchidopexy
• If non-viable → Orchidectomy (removal)

📝 Exam Clues & Clinchers

• Teenage boy with sudden groin pain + vomiting → think torsion
• High-riding, horizontal testis + absent cremasteric reflex → torsion
• Tme-critical surgical emergency