The bell-clapper deformity of the testis: The definitive pathological anatomy

Taghavi, Kiarash; Dumble, Charlotte; Hutson, John M.; Mushtaq, Imran; Mirjalili, S. Ali

doi:10.1016/j.jpedsurg.2020.06.023

Cited by 27 publications

(12 citation statements)

References 49 publications

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“…The incidence of a BCA varies in the literature. A recent systematic review states that the prevalence in an autopsy series can range anywhere from 4.9‐16% 14 . Our series demonstrates a 19% prevalence of a BCA in all children explored for testicular pain.…”

Section: Discussionmentioning

confidence: 63%

Surgical management of the acute paediatric scrotum: a three‐year single centre experience

Muraliharan

Jacob

Bollu

et al. 2021

ANZ Journal of Surgery

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Background Acute scrotal pain is a common emergency presentation in paediatric surgery. Torsion of the testicular appendage (TTA) is the most common cause for pain, with testicular torsion (TT) being the sinister pathology to exclude. Outcomes are time dependent, and a delayed scrotal exploration could result in testicular loss. Methods We performed a review on a large retrospective cohort of 449 surgical scrotal explorations at a large referral paediatric surgical centre over three years. Results Only about a quarter of children with testicular pain presented within 4 h. TT is commonly associated with nausea and an abnormal lie. Two children with a classical ‘blue dot’ sign were later found to have a testicular torsion. 19% of all children with a TTA were also seen to have Bell clapper anomaly (BCA). Recurrent testicular pain was associated with 84.7% (p < 0.001) of BCA. Intra‐operative diagnosis of TTA correlated with histopathology in 84.6% (p=0.021). The sensitivity of intraoperative diagnosis was 90.9% with a specificity of 75.3%. Conclusion Routine histopathology for a classic TTA may not be required especially in resource poor situations. All children presenting with recurrent episodes of testicular pain must be considered for surgical scrotal exploration. And in view of the incidence of BCA in this cohort, all scrotal explorations for acute scrotal pain should include an assessment for BCA.

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Section: Discussionmentioning

confidence: 63%

Surgical management of the acute paediatric scrotum: a three‐year single centre experience

Muraliharan

Jacob

Bollu

et al. 2021

ANZ Journal of Surgery

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“…However, it should be followed by subsequent semi-elective surgical fixation [ 2 , 3 , 11 ]. When performing surgical fixation, a bilateral approach should be considered, as the predisposing bell-clapper deformity occurs bilaterally in 66-100% [ 3 , 10 ]. The incidence of this deformity ranges between 12 and 16% [ 10 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…When performing surgical fixation, a bilateral approach should be considered, as the predisposing bell-clapper deformity occurs bilaterally in 66-100% [ 3 , 10 ]. The incidence of this deformity ranges between 12 and 16% [ 10 , 24 ]. Although recent literature on this topic is scarce, prophylactic contralateral fixation has not been shown to increase morbidity and is therefore recommended [ 1 , 2 , 4 , 11 , 14 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most torsions cannot be related to any particular event, although 4–10% are diagnosed following a testicular trauma [ 3 , 8 , 9 ]. The bell-clapper deformity is characterized by a complete enclosing of the testis, epididymis and the distal part of spermatic cord by the tunica vaginalis and predisposes for intravaginal testicular torsion [ 10 ]. The familial inheritance of this deformity is a subject of discussion [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…The first type is a twist occurring inside the vaginal tunic and is typical in adolescent boys or young adults. In this case, the cause would be an abnormal graft of the posterior side of testis to the scrotum, so that the testes can freely rotate, with the formation of a bell‐clapper deformity 1 . In the second case, extravaginal torsion is determined by an abnormal descent of the testicle in the neonatal period and it is typically at the inguinal canal 2 .…”

Section: Introductionmentioning

confidence: 99%

The limits of diagnosis of testicular torsion in the child: Medicolegal implications in clinical practice

Aquila

Abenavoli

Sacco

et al. 2021

Clinical Case Reports

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The bell-clapper deformity of the testis: The definitive pathological anatomy

Cited by 27 publications

References 49 publications

Surgical management of the acute paediatric scrotum: a three‐year single centre experience

Surgical management of the acute paediatric scrotum: a three‐year single centre experience

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

The limits of diagnosis of testicular torsion in the child: Medicolegal implications in clinical practice

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