torsion of the testis

Testicular torsion is a medical emergency.

It is caused by a congenital abnormality of the covering of the testis that allows the testis to twist within its sac. This twisting can cut off the blood supply to the testis, with prompt and dramatic effect.

There is sudden pain and swelling of the scrotum. The testis becomes exquisitely painful and is difficult to examine. Swelling is usually absent above the testis in the area of an inguinal hernia.

This condition is most common between ages 7 and 12. It can be confused with torsion of the appendix of the testis, or epididymitis in the child over 13 or so.

Prompt exploratory surgery is imperative in any case where torsion of the testis is suspected. If the testis is explored within 6 hours of torsion, the salvage rate for the testis is up to 90%. Survival decreases rapidly after that time, and the testis may need to be removed.

The appendix of the testis, a vestigal structure of membranes attached to some testes, may likewise undergo painful twisting. Torsion of the appendix of the testis is also painful, but not as dramatically so. While the diagnosis may sometimes be made clinically, surgery is nonetheless often the only way to be sure there is no torsion of the testis.

Torsion of the testis also can occur prenatally. If this is the case, the testis is abnormal and almost never salvagable. The abnormal testis is removed, and the other side often explored to make sure the remaining testis will not twist.

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