Testicular Torsion

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Torsion of Torsion of Testis Testis By- By- Gaurav Jadhav. Gaurav Jadhav. Vaibhav Devkar. Vaibhav Devkar.

Transcript of Testicular Torsion

Page 1: Testicular Torsion

Torsion ofTorsion ofTestis Testis

By-By-Gaurav Jadhav. Gaurav Jadhav. Vaibhav Devkar.Vaibhav Devkar.

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Torsion of TestisTorsion of TestisTorsion of testicles is an uncommon

condition which is limited to peripubertal males.

It causes strangulation of blood supply to testis and unless treated within 3 to 4 hrs, testicular atrophy is inevitable.

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Predisposing FactorsPredisposing Factorsa) Inversion of testisb) Long mesorchium-in this case

torsion of testis takes place without torsion of spermatic chord.

c) Undescended and ectopic testis.d) Voluminous tunica vaginalis-gives

adequate space to testis to rotate.

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PathologyPathologySpasm of cremaster muscle is main

initiating factor.Torsion usually occurs from without

inwards, i.e.-left testicle rotates-anti clockwise-right testicle rotates- clockwiseIn torsion along with vascular occlusion

there is oedema of testis and chord which gradually leads to gangrene of testis and epididymis.

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HistoryHistory• The patient's history often indicates

recent hard physical work, vigorous exercise, or trauma to the genital area; however, testicular torsion can also occur without any apparent reason

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SymptomsSymptoms• Severe pain in one testicle or in groin

region.• Pain is sudden and agonizing; often

referred to lower abdomen.• Other symptoms may include swelling of

the scrotum, blood in the semen, nausea and vomiting, and fever.

• A few patients feel the need to urinate frequently.

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ExaminationExamination• LOCALThe affected testicle is swollen and

tender. It usually lies higher in the scrotum

than the unaffected testicle and may be lying in a horizontal position.

The scrotum may be normal or red and oedematous.

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ExaminationExaminationOther examinationIt is difficult to differentiate testicular

torsion from epididymo-orchitis.Elevation of scrotum relieves pain in

epididymo-orchitis, but increases in torsion of testis and spermatic chord.

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Differential DiagnosisDifferential DiagnosisTwo main D/d are i) Acute epididymo-orchitis- in c/o

torsion of completely descended testis. Epididymitis is unusual before age of 24 yrs.

ii) Strangulated inguinal hernia- in c/o torsion of incompletely descended testis.

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DiagnosisDiagnosisDoppler stethoscope in conjugation

with ultrasound is simple test to diagnose this condition.

Testis which is made ischaemic with torsion will not echo sound; while hypervascularised epididymis will increase sound.

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TreatmentTreatmentIf the pt. comes early- Manual Detorsion may be tried.If detorsion is successful surgical

fixation can be done within few days; if it fails -immediate surgical exploration should be performed.

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Surgical procedureSurgical procedure• The surgeon makes an incision in

the patient's scrotum and untwists the spermatic cord.

• The affected testicle is inspected for signs of necrosis, or tissue death.

• If too much tissue has died due to loss of blood supply, the surgeon will remove the entire testicle.

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Surgical procedureSurgical procedure• If the tissue appears to be healthy,

the surgeon sutures the testicle to the wall of the scrotum and then closes the incision.

• In most cases, the surgeon will also attach the unaffected testicle to the scrotal wall as a preventive measure.

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Normal anatomyNormal anatomy

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Torsion of left testicleTorsion of left testicle

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Surgical CorrectionSurgical Correction

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PrognosisPrognosis

If detorsion done within 12 hrs-good result with 100% success.

If detorsion is done from 12 to 24 hrs-recovery possible in majority of cases.

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PrognosisPrognosis

Detorsion can be advised even from 24 to 36 hrs-but preservation is doubtful.

If case is delayed by more than 48 hrs-orchidectomy is more advisable than detorsion operation.

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