Testicular Torsion
Differential Diagnosis
- Testicular torsion
- Torsion of testicular/epididymal appendage
- Orchitis - mumps / epididymo-
- Incarcerated hernia
- Hydrocoele
Management
- History
- Examination
- Investigations
- Scrotal USS: can demonstrate flow of blood in testicular artery. Poor negative predictive value
- Treatment
- When suspected immediate exploration is indicated within 8 hours (after 8 hours, infarcted testis is unlikely to recover
Surgical Approach
- Access scrotum
- Skin, dartos, external spermatic fascia, cremasteric fascia, internal spermatic fascia, tunica vaginalis/albuingea, testis ("Some damn Englishman called it the testis")
- Assess testicle for viability
- Release torted testis
- Wrap in warm soaked gauze for 10minutes
- Fix other testicle
- Explore contralateral hemiscrotum
- Insert 3point fixation for testis to tunica vaginalis
- Close with non-absorable sutures
- If viable, fix; if not viable clamp, ligate and remove
