Practice Easily Missed?

Testicular torsion

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c3213 (Published 27 July 2010) Cite this as: BMJ 2010;341:c3213
  1. Bhaskar K Somani, specialist registrar in urology1,
  2. Graham Watson, general practitioner2,
  3. Nick Townell, consultant urological surgeon1
  1. 1Ninewells Hospital, Dundee DD1 9SY
  2. 2Dundee
  1. Correspondence to: N Townell nicktownell{at}nhs.net
  • Accepted 18 May 2010

Case scenario

A 17 year old man presented with a 24 hour history of intermittent testicular pain without any urinary symptoms. The testis was mildly tender with no swelling and felt normal in size, shape, and position. A diagnosis of possible orchitis was made, but he was referred for further assessment. Surgical exploration found an engorged testis, confirming a diagnosis of intermittent torsion.

Testicular torsion is a surgical emergency requiring prompt diagnosis and specialist referral. In all cases of suspected testicular torsion, emergency surgical exploration is necessary to avoid loss of the testicle.

How common is it?

Testicular torsion has a bimodal age distribution, occurring either soon after birth or more commonly at puberty, but it can occur in any age group. The annual incidence in males <25 years is 1 in 4000.1 The incidence of testicular torsion, torsion of testicular appendage, and epididymitis was 16%, 46%, and 35%, respectively, in 238 children presenting with acute scrotal pain.2 In a prospective audit of 173 scrotal explorations for suspected testicular torsion over an 11 year period (1998-2008) in our centre, 89 (51%) had testicular torsion and 16 (9%) required an orchidectomy due to delayed presentation, with 75% (12) presenting 24 hours or more …

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