Testicular torsion is the twisting of the testis along the longitudinal axis of the spermatic cord causing torsional strangulation of the spermatic cord vessels, resulting in ischemic lesions of the testis and epididymis.
[Etiology and pathogenesis
Testicular torsion is caused by congenital overgrowth of the spermatic cord, incomplete connection of the epididymis and testis, and dysplasia of the lead band.
There are two types of testicular torsion: intrasphincter type and extrasphincter type. Most of the torsions of spermatic cord and testicular and epididymal torsions occur within the sphincter in childhood and should be operated in time. Testicular torsion usually occurs in 2-24h with testicular and epididymal necrosis. If the ischemia time exceeds 8h, the chance of testicular atrophy is extremely high.
Diagnosis
(A) Symptoms
1.Acute onset, testicular swelling and pain.
2.The testis in the scrotum or inguinal canal is obviously enlarged with persistent pain.
3.A few children may have gastrointestinal symptoms, such as nausea and vomiting, which are reflexive and mostly not violent, and there is no obvious fever or abnormal urination.
4. There is often a history of cryptorchidism.
(II) Physical signs
1. Redness and swelling of the scrotum or inguinal skin.
2. Scrotal and inguinal masses with obvious pressure pain, and normal testicles cannot be found.
1. The testicular reflex is weaker than the opposite side or completely disappears.
(C) Laboratory examination
1. Doppler ultrasound auscultation
The blood flow is reduced or disappeared, and the vascular sound is correspondingly weakened or disappeared.
2.Color Doppler
On comparative examination of both sides, the affected testis is obviously swollen and the arterial blood supply disappears.
3.Nuclear scan shows reduced vascular phase, decreased or disappeared parenchymal phase, and “fried ring sign”.
(IV) Differential diagnosis
1.Acute epididymitis: color Doppler testicular comparative examination on both sides, such as the loss of arterial blood supply of the affected testicle is generally testicular torsion. In contrast, if it is epididymitis, the testis and epididymis on the side of the lesion are rich in blood flow. Epididymitis raises the reflex to exist, while testicular torsion raises the testicular reflex to weaken or disappear.
2. Testicular adnexal torsion: In the early stage, if the scrotum of the child is not obviously red or swollen, a small painful nodule may be felt on the testicle, and a dark blue spot is visible through the scrotal skin. The spermatic cord is usually not swollen and there is no pressure pain in the groin area.
Treatment
1. Surgical exploration shows that there is often bloody exudate in the sphincter. The testis, epididymis and the junction of the spermatic cord are twisted and thin. According to the time of torsion and the degree of ischemia, the testis is light red, pale white, blue or black. Almost all testes were preserved within 2 h of onset, and almost all testes were necrotic after 24 h. After torsion and repositioning, the blood supply to the testis can be observed by applying warm saline for a few minutes, and at the same time, several small holes can be punctured on the side of the testis to the epididymis with the tip of a needle to remove the blood to facilitate the recovery of the blood supply and to check the blood supply to the testis. In case of adnexal torsion, resection is feasible.
2.Testicular fixation If the blood supply to the testis is good, testicular fixation is feasible.
3.Orchiectomy If the testicle is black, it is confirmed that the testicle is ischemic and necrotic, orchiectomy should be performed.
Prevent]
The ischemic necrosis after testicular torsion is related to the onset time of testicular torsion and the degree of torsion, almost all testicles within 2h can be preserved, and almost all testicles after 24h are necrotic. If the testis is torsioned 90 degrees, the testis is necrotic only after 7 days, and if the testis is torsioned 720 degrees, testicular infarction occurs in 2 hours. Therefore, once testicular torsion is suspected, surgical exploration should be actively performed.