Pediatric Testicular Torsion Clinical Presentation

Updated: Jun 21, 2021
  • Author: Krishna Kumar Govindarajan, MBBS, MCh, MS, MRCS, DNB; Chief Editor: Marc Cendron, MD  more...
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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.


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). [30, 31] 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. [31]

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.