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Pediatric Testicular Torsion Clinical Presentation

  • Author: Krishna Kumar Govindarajan, MBBS, MS, DNB, MRCS, MCh; Chief Editor: Marc Cendron, MD  more...
 
Updated: Mar 30, 2015
 

History

The typical presenting symptom of pediatric testicular torsion is severe scrotal pain of acute onset, commonly in association with scrotal swelling and erythema. Nausea and vomiting are common, as is local scrotal redness. Although most patients have severe pain with a rapid onset, occasional patients present with a history of pain lasting many hours or even days.

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Physical Examination

Upon examination, the classic findings of testicular torsion include an exquisitely tender, high-riding testis with an abnormal (transverse) orientation. Scrotal swelling and edema are common.

The cremasteric reflex is generally absent in cases of testicular torsion. In one series, the absence of cremasteric reflex was 100% sensitive for testicular torsion but only 66% specific (because many boys have an absent or decreased cremasteric reflex at baseline).[26, 27] An intact cremasteric reflex in the setting of torsion has been reported; thus, the presence of the reflex should not be used to rule out torsion in a patient whose presentation is otherwise suggestive of torsion.[27]

Intermittent torsion that persists with recurrent attacks of pain requires a careful examination to reveal subtle signs, such as excess testicular mobility and transverse testicular orientation. An elective scrotal exploration may be planned to look for a bell clapper deformity and to avoid a dead testicle.

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Contributor Information and Disclosures
Author

Krishna Kumar Govindarajan, MBBS, MS, DNB, MRCS, MCh MNAMS, FAIS, FICS, FACS, FEBPS, Assistant Professor and Consultant Pediatric Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research, India

Krishna Kumar Govindarajan, MBBS, MS, DNB, MRCS, MCh is a member of the following medical societies: American College of Surgeons, International College of Surgeons, British Association of Paediatric Surgeons, Association of Surgeons of India, Indian Association of Pediatric Surgeons, Association of Colon and Rectal Surgeons of India, Association of Minimal Access Surgeons of India, National Academy of Medical Sciences (India)

Disclosure: Nothing to disclose.

Coauthor(s)

Caleb P Nelson, MD, MPH Assistant Professor of Surgery (Urology), Department of Urology, Harvard Medical School; Consulting Staff, Department of Urology, Children's Hospital Boston

Caleb P Nelson, MD, MPH is a member of the following medical societies: American Urological Association, Endourological Society, Phi Beta Kappa, Society for Pediatric Urology, Society for Fetal Urology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, New Hampshire Medical Society, Society for Pediatric Urology, Society for Fetal Urology, Johns Hopkins Medical and Surgical Association, European Society for Paediatric Urology

Disclosure: Nothing to disclose.

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Perinatal testicular torsion.
Intravaginal testicular torsion with ischemia in adolescent boy.
Torsion of undescended testis.
Torsion of testis, with cord twist clearly demonstrated.
Torsion of appendix testis.
 
 
 
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