Asian Journal of Case Reports in Surgery

Testicular torsion is a severe acute urological emergency caused by twisting of the spermatic cord. Unfortunately, its importance is still underestimated in everyday life. It requires prompt diagnosis and treatment. Early-detected testicular torsion can be cured in almost every case, whereas late identification may lead to loss of the testicles. We report two rare cases of post-traumatic testicular torsion and we will discuss the mechanism, diagnosis and the importance of rapid surgical management outcome, based on recently published articles.

In the 1st case, is about an adolescent A.K., 18 years old, without any particular pathological history, victim of a scrotal trauma whose mechanism is a kick on the testicles (brawl) leading to a closed trauma with the appearance of an atrocious pain. The patient was seen 2 hours after the occurrence of the trauma, the clinical examination found a conscious patient with a right testicle ascended to the inguinal ring, ecchymotic scrotum and a very intense pain on palpation. An ultrasound with color Doppler study was carried out in front of the traumatic context which had objectified a twisting spermatic (spiral twist) cord associated with hydrocele of low abundance. Surgical exploration found a reactive hydrocoele and a twisted spermatic cord with a viable testicle. An emergency detorsion was performed followed by orchidopexy. In the 2st case, is 16 years old boy, was consulting for a painful post-traumatic right scrotal swelling, that has been evolving for 12 hours. Clinical examination showed a patient conscious, with a right hemi -scrotum increased in volume, ascending, painful on palpation. The ultrasound scan showed a ruptured albuginea with hydrocele. Surgical exploration revealed a hematoma at the expense of the epididymis with the presence of a spiral twist at the level of the spermatic cord and a necrotic right testicle. The procedure consisted of detorsion and resuscitation with normal saline 0.9%. Despite the reanimation, the testicle kept the same aspect. An orchiectomy was performed.

The message is that the urological surgeon must keep in mind that scrotal trauma can lead to testicular torsion. So, consciousness and constant vigilance are required in order to avoid a catastrophic delay that can lead to an orchiectomy, which can have serious consequences.