A 12-year-old boy with sudden onset of left lower abdominal pain for 34 hours and left testicular pain for 24 hours was admitted to the hospital. The child first presented with left lower abdominal pain with nausea and vomiting, and the left testicular pain was not obvious. The emergency abdominal CT indicated no obvious lesion in the abdominal cavity, and the diagnosis was intestinal spasm, and the abdominal pain was relieved after treatment. The left scrotum was explored during emergency surgery, and the testicle was squeezed out and found to be blackish-purple, twisted 3 and a half times, like a big twist, and the color did not change after 5 minutes of observation after resetting the testicle. Testicular torsion is the lack of blood flow to the testicle due to torsion of the spermatic cord, or even no blood flow to the testicle at all, causing ischemia and pain or even necrosis. The incidence is about 1 in 1000 and is common in men under 25 years of age.
It occurs in men under 25 years of age, most often in men between 12 and 20 years of age and, of course, in infants within the first week of life. Patients usually present with sudden onset of abdominal pain and swelling of the testicles, which may extend to the groin area and lower abdomen. Ultrasound examination for blood flow to the testicle is currently an important method of diagnosing testicular torsion. Early surgery is the most important way to save the testicle, and the testicle can mostly be salvaged within 6 hours, after 6 hours the probability of testicular necrosis increases with the passage of time. If testicular torsion is highly suspected, open exploration is necessary. If surgical correction is performed within a short time after torsion (within 6 hours), the testicle can usually be preserved and testicular fixation should be done on both sides. However, if the testicle has become irreversibly necrotic due to prolonged torsion, orchiectomy is required and the opposite testicle should be immobilized at the same time during surgery to prevent future torsion of the opposite testicle as well. Testicular torsion may have an effect on the body’s immune system, causing the body’s immune system to recognize testicular antigens and thus causing infertility. Therefore, the possibility of testicular torsion should not be ignored in acute lower abdominal pain, and it is important to seek urgent medical attention to save the testicle as soon as possible!