Testicular Torsion in Children

Testicular torsion is a twisting of the spermatic cord, artery, and vein that go to the testicle. This twisting prevents blood from reaching the testicle. Testicular torsion is a medical emergency.

The testicle can usually be saved if the torsion is treated within 4–6 hours from the time the twisting started. If the torsion is left untreated for too long, the testicle will be damaged beyond repair and will have to be removed.

What are the causes?

The most common cause of this condition is a deformity in which the tissue that connects the testicle to the scrotum is missing (bell clapper deformity). This deformity allows the testicle to rotate and the spermatic cord to get twisted.

Other possible causes include:

• Absence of the tissue that connects the testicle to the scrotum. This is often seen in newborns, when the tissue has not formed yet.
• A tumor or mass in the testicle.
• An unusually long spermatic cord.

What increases the risk?

This condition is more likely to develop in:

• Newborns.
• Adolescents.

What are the signs or symptoms?

The main symptom of this condition is severe pain in your child’s testicle. Other symptoms may include:

• Swelling, redness, tenderness, or hardening of the scrotum.
• Pain that spreads to the abdomen.
• One testicle that appears to be larger than the other.
• A testicle that is higher than normal.
• Nausea.
• Vomiting.

How is this diagnosed?

This condition is diagnosed with a physical exam and medical history. Your child may also have tests, including:

• An ultrasound.
• An X-ray.
• An MRI.
• Urine tests.

How is this treated?

This condition is treated with surgery. The type of surgery depends on how severe the condition is and how much time has passed since the condition started:

• If it has been less than 4–6 hours since the condition started, the condition will be treated with surgery to untwist and evaluate the testicles. Before the surgery, a health care provider may untwist the testicle with her or his hands if your child’s testicle can still move and if it does not cause your child too much pain. After surgery, stitches (sutures) will be sewn in to secure the testicles and prevent the condition from happening again.
• If the torsion is severe or if a lot of time has passed since the torsion started, the condition will be treated with surgery to remove the affected testicle.

Summary

• Testicular torsion is a twisting of the spermatic cord, artery, and vein that go to the testicle.
• Testicular torsion requires emergency treatment. If the torsion is left untreated for too long, the testicle will be damaged and have to be removed.
• The most common symptom of this condition is severe pain in the testicle.
• Surgery should be done as soon as possible after torsion occurs.