Testicular Torsion in the Absence of Severe Pain: Considerations for the Pediatric Surgeon

Abstract

Testicular torsion is a surgical emergency. Early diagnosis and surgical treatment are vital in order to preserve the affected gonad. Current surgical teaching emphasizes sudden, severe, persistent, unilateral scrotal pain as a cardinal symptom of testicular torsion. We present the case of unilateral testicular torsion in a 14-year-old patient who presented with the absence of severe pain. Despite a delayed presentation to the emergency department, the gonad could be salvaged successfully. Literature on the topic of testicular torsion presenting with minimal pain is limited. Nevertheless, pediatric surgeons might be faced with cases similar to the one we describe. Underestimating this phenomenon might lead to a delay of treatment. In such cases, ultrasound can be a beneficial addition in the diagnosis and accelerate definitive operative treatment. The presented case clearly demonstrates that, although we do not include testicular torsion without severe pain in our surgical teaching algorithms, we might encounter it in our clinical practice.

Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting; a multicentre longitudinal study

“…Secondly, In this study, age was not signi cantly associated with testicular salvageability as was seen in other studies (15). This is possibly because this study had only one neonate, thus a small representation to demonstrate validity of this association.…”

“…Further, the variations in age of the participants in the different studies could explain the difference in salvage rates. Compelling evidence from literature suggest that neonates have a salvage rate of about 9% (15), and in our study, we had only one neonate.…”

Patient Query in Adolescent Testicular Torsion Cases: "Was it Necessary to Mention My Scrotal Pain?"

“…Patient-specific factors contributing to delayed presentation may include fear, embarrassment, particularly among adolescent children, reduced pain sensitivity, or deficient communication abilities, particularly among very young or neurologically impaired patients [5,10]. External factors leading to delayed diagnosis or treatment may include inadequate healthcare system infrastructure, lack of clinical expertise among physicians, or misjudgment of the condition by examining healthcare professionals [1,5,11]. The reasons behind late diagnosis in our patient cohort included adolescent sexual embarrassment and a lack of awareness regarding TT.…”

“…Although testicular pain is a common presentation within the emergency setting, adolescent patients may sometimes struggle to discern or localize their pain and may feel too embarrassed to admit to testicular discomfort [4]. One case report highlighted a delayed TT diagnosis in a patient who was assessed for neurological deficits due to the absence of pain [11]. Another study focused on TT pain, describing the resolution of pain as the "honeymoon period" [9].…”

Delayed Management of Pediatric Testicular Torsion with Absence of Severe Pain : An Evidance-Based Case Report

“…The differential diagnosis accounts for tumor markers, duplex sonography, urine analysis, blood analysis, and more diagnostic tests. 10 To prevent testicular necrosis, detorsion of the testicle should be accomplished within 6 to 8 hours. 11 One explanation for this could suggest that older kids can express their symptoms more easily.…”