When torsion occurs the testes rotates along the spermatic cord. During the rotation, it obstructs the blood flow. The stoppage in blood flow results in ischemia and no oxygen supply to the testes. The degree of damage to the testes depends on the duration of the torsion and the degree of twisting of the spermatic cord. Changes are evident in the testes soon after torsion and are reversible up to 4 hours. However, after 24 hours of torsion, the testes is almost always non functional and salvage is impossible.
Differential Diagnosis
Testicular torsion is a surgical emergency and if there is going to be any hope of salvage; it must be rapidly diagnosed and treated. Any delay in the diagnosis almost always leads to loss in the testes. Over diagnosis of the condition leads to unnecessary surgery. Data from hospital records indicate that testicular pain is quite frequent in teenagers and young adults. At least 20-40% of young males complain of some type of testicular pain at some point.
- Conditions which can mimic testicular torsion include
- trauma to the scrotum
- epididymitis (infection of the spermatic cord)
- orchitis (infection of the testis)
- incarcerated hernia
- varicocele
- idiopathic scrotal edema
- torsion of the appendix testis
Whenever there is trauma to the groin area, there is a general tendency to always attribute the scrotal pain entirely to trauma and become oblivious to the presence of testicular torsion. However, if the pain lasts more than one hour after the trauma, the testicle should always be evaluated for possible trauma-induced torsion.
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