Open Access

ARTICLE

An unusual presentation of testicular torsion in children: a single – centre retrospective study

Zenon Pogorelic^1,2, Christopher Neumann², Miro Jukic¹

1 Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
2 University of Split, School of Medicine, Split, Croatia
Address correspondence to Dr. Zenon Pogorelic, Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia

Canadian Journal of Urology 2019, 26(6), 10026-10032.

Abstract

Introduction: The aim of this study was to investigate demographic and clinical characteristics and outcomes of the treatments of the patients with an unusual presentation of testicular torsion (TT) and to clarify their peculiarities.
Material and methods: From January 1999 until December 2017, the case records of 149 patients who underwent surgery for TT were retrospectively reviewed. Out of that number, 25 patients were identified with unusual presentation of an acute scrotum (14 patients who presented with abdominal pain only, and 11 who presented with testicular torsion in the inguinal canal).
Results: The median age of all children with TT at the time of surgery was 14 years. The duration of the symptoms varied substantially and ranged from 1 hour to 120 hours with a median of 6 hours, with only 63 (42.3%) out of the 149 patients staying below the golden 6 hours. Only 2/11 (18.2%) children in the inguinal group and 5/14 (35.71%) children in the abdominal group presented within 6 hours. In the group with inguinal TT, the median age was 13 years with a median duration of symptoms of 24 hours. The symptoms were mostly abdominal pain (90.9%), followed by groin pain (45.5%) and nausea (45.5%). In 6 out of 11 children, the first physical examination did not include a genital examination. In the group with abdominal pain, the median age was 13 years, with a median duration of symptoms of 17 hours. The symptoms were limited, besides abdominal pain, to groin pain (42.8%) and nausea (50%). In 9 out of 14 children, the first physical examination did not include a genital examination. The rate of orchidectomy in the inguinal TT group was 54.5%, while in the abdominal group, it was 57.1%.
Conclusion: Testicular torsion, particularly in regard to torsion in the inguinal canal or presenting dominantly with abdominal pain, can be easily misdiagnosed but needs to be recognized on time to salvage the affected testicle. A complete physical examination, including a genital examination, needs to be performed in each male patient presenting with lower abdominal or groin pain.

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