Twisting of the spermatic cord causing ischaemia; a time-critical surgical emergency.
Clinical features
- • Sudden severe unilateral testicular pain
- • Nausea and vomiting
- • High-riding testis with horizontal lie
- • Absent cremasteric reflex, no relief on elevation
Investigations
- • Clinical diagnosis — do NOT delay for imaging
- • Doppler ultrasound only if the diagnosis is genuinely uncertain and immediately available
Management
- • Nil by mouth, analgesia, urgent surgical exploration within 6 hours
- • Bilateral orchidopexy at exploration
- • Orchidectomy if non-viable
Clinical pearls
- • Salvage exceeds 90% within 6 h and falls below 10% after 24 h
- • Torsion of the appendix testis gives a 'blue dot' sign and is managed conservatively
Related in WardRound
Educational — verify locally.
