Relationship between Trauma and Acute Scrotum: Test Torsion and Epididymal Appendix Torsion

Authors: Saimir Heta, Kastriot Haxhirexha, Virtut Velmishi, Nevila Alliu, Ilma Robo

Abstract:

Background: Testicular rotation can occur at any age. The possibility to save the testicle is the fastest possible surgical intervention which is indicated by the presence of acute pain even at rest. The time element is more important to diagnose and proceed further with surgical intervention. Testicular damage is a consequence which mainly depends on the moment of onset of symptoms, at the time when the symptoms are diagnosed, the earliest action to be performed is surgical intervention. Sometimes medical tests are needed to confirm a diagnosis, or to help identify another cause for symptoms; for example, the urine test, that is used to check for infection, associated with the scrotal ultrasound test. Control of blood flow to the longitudinal supply vessels of the testicles is indicated. The sign that indicates testicular rotation is a reduction in blood flow. This is the element which is distinguished from ultrasound examination. Surgery may be needed to determine if the patient’s symptoms are caused by the rotation of the testis or any other condition. Discussion: As a surgical intervention of the emergency, the torsion of the test depends very much on the duration of the torsion, as the success in the life of the testicle depends on the fastest surgical intervention. From the previous clinic, it is noted that in any case presented to the pediatric patient diagnosed with testicular rotation, there is always a link with personal history that the patient refers to the presence of a previous episode of testicular trauma. Literature supports this fact very logically. Conclusions: Salvation without testicular atrophy depends closely on establishing the diagnosis of testicular rotation as soon as possible. Following the logic above, it can be said that the diagnosis for rotation should be performed as soon as possible, to avoid consequences that will not be favorable for the patient.

Keywords: Acute scrotum, testicular torsion, newborns, infants, clinical presentation.

References:

[1] Mäkelä E, Lahdes-Vasama T, Rajakorpi H, Wikström S. A 19-year review of paediatric patients with acute scrotum. Scand J Surg. 2007;96:62–66. (PubMed)
[2] Visser AJ, Heyns CF. Testicular function after torsion of the spermatic cord. BJU Int. 2003;92:200–203. (PubMed)
[3] Barbosa JA, Tiseo BC, Barayan GA, et al. Development and initial validation of a scoring system to diagnose testicular torsion in children. J Urol. 2013;189:1859–1864. (PubMed)
[4] J Pediatr Surg. 2018 Aug 8. pii: S0022-3468(18)30436-6. doi: 10.1016/j.jpedsurg.2018.07.006. (Epub ahead of print); Controversies in the management of neonatal testicular torsion: A meta-analysis.; Monteilh C, Calixte R, Burjonrappa S.
[5] Urol Case Rep. 2018 Nov; 21: 1–2.; Published online 2018 Aug 4. doi: (10.1016/j.eucr.2018.08.003); PMCID: PMC6086218; PMID: 30116718 ”Testicular torsion in older men: It must always be considered” Ibrahim Mejdoub, Mohamed Fourati, Sami Rekik, Nouri Rebai, Mourad Hadjslimen, and Mohamed Nabil Mhiri
[6] Grace S. Hyun; Testicular Torsion; Rev Urol. 2018; 20(2): 104-106.doi: (10.3909/riu0800); PMCID: PMC6168322; PMID: 30288149
[7] Ahmadnia H, Dolati M, Ghanadi A, Younesi Rostami M, Akhavan Rezayat A; “Effect of Unilateral Iatrogenic Torsion on Contralateral Testis in Rat, Prepubertal and Postpubertal” Urol J. 2018 Sep 11. doi: 10.22037/uj.v0i0.4289. (Epub ahead of print).