Testicular torsion
- Lesion
Twisting of the spermatic cord blocks venous outflow first and then arterial supply; the testis can die within hours.
What it is
Torsion of the spermatic cord occurs in two settings: in newborns, as extravaginal torsion in utero or shortly after birth, and in adolescents and young adults, usually intravaginal, through a bell-clapper deformity in which the tunica vaginalis surrounds the testis completely and lets it rotate freely. Twisting first obstructs thin-walled veins, causing congestion and hemorrhage, and then the arteries, causing hemorrhagic infarction. It is a urologic emergency.
Structure
- Testis swollen, dark red to purple, with hemorrhage in the parenchyma and tunica.
- Microscopy: intense congestion, interstitial hemorrhage, then coagulative necrosis of tubules.
- Late: shrunken fibrotic testis.
Clinical notes
- Sudden severe scrotal pain, often at night or after exercise, with nausea, a high-riding testis and absent cremasteric reflex.
- Doppler ultrasound shows absent flow, but imaging should not delay surgery when suspicion is high.
Test yourself
Think of the answer, then tap the question to see it.
What anatomical defect predisposes to torsion in adolescents?
The bell-clapper deformity, in which the tunica vaginalis surrounds the testis completely and leaves it free to rotate.
Why is the infarction hemorrhagic?
Veins are compressed before arteries, so blood keeps entering but cannot leave.
Why is the other testis fixed during surgery?
The predisposing anatomy is often bilateral.
Elsewhere in DurgiPedia
- Infarction: red vs white, and what decides the damage
- Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Testicular Torsion (StatPearls (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.