Testicular Torsion and Irreversible Loss in an Adolescent Male: A Harrowing Case Report With Emphasis on Timely Intervention and Literature Review

Abstract

Testicular torsion is a condition characterized by the twisting of the testis and spermatic cord within the scrotum, resulting in the obstruction of venous return and subsequent swelling. If left untreated, the torsion can progress to block the arterial blood supply, leading to ischemia. Prolonged ischemia can result in testicular necrosis and decreased fertility. Recognizing the urgency of this condition, timely diagnosis and management are crucial. In this clinical case, a 16-year-old male presented with left-sided scrotal pain following a minor trauma. Despite prompt medical attention, the delay in seeking treatment resulted in irreversible testicular necrosis. The case emphasizes the urgency of diagnosing and managing testicular torsion to prevent serious consequences such as testicular loss and reduced fertility. It serves as a poignant reminder for healthcare professionals to remain vigilant in recognizing this urological emergency and advocating for timely intervention to optimize patient outcomes.

Torsion of a cryptorchidism testicle in a toddler

“…Retrospective data http://www.antpublisher.com/index.php/UTJ/index from 558 children from Croatia showed the importance of early presentation and surgical within 6 hours was associated with a testicular salvage rate of 90-100%, whereas children presenting 6 to 12 hours and 12 to 24 hours after symptom onset had salvage rates of 20-50% and 0-10%, respectively. However, early presentation is a well-documented and critical step in increasing testicular preservation rates [3,4,8]. In our opinion, the above case is an important learning point for many reasons.…”

“…Intravaginal torsion is most common in older children and adults. Extravaginal torsion is often seen in newborns and indicates twisting of the spermatic cord outside of the tunica vaginalis [1,3,5]. Impalpable testis and an inguinal mass on the ipsilateral side are the classic presentation and should raise the suspicion of torsion of the undescended testis.…”

“…To date, there are few reports of torsion of the undescended testis in normal children in the literature. In this case report, we present a case of testicular torsion of the undescended testis in an otherwise normal toddler and briefly review the relevant literature to further highlight this urologic emergency [3][4][5]. Testicular torsion occurs when the testicle twists, resulting in decreased blood flow to the affected testicle.…”

“…This is an emergency condition and immediate surgical repair can result in testicular salvage. The testicular salvage rate is approximately 100 percent if surgery (untwisting of the testis) is performed within 6 hours; the salvage rate drops to 20 percent if surgery is delayed for 24 hours [3,4]. There are two types of torsion of the testis, it can be intravaginal or extravaginal.…”

“…In Bell-Clapper malformation, there is a high investment of the tunica vaginalis on the testis, which allows rotation of the spermatic cord within the sac, leading to intravaginal torsion of the testis. This malformation is bilateral and therefore justifies bilateral exploration and fixation of both testes even in cases of unilateral testicular torsion [1][2][3].…”