Testicular Torsion

Testicular torsion was first described in the medical literature by Delasiauve in 1840, when he reported on a surgery performed for suspected inguinal hernia that instead revealed torsion of an undescended testicle in a 15-year-old male [1, 2]. Torsion is an emergent condition that occurs in males with predisposing anatomy when the testicle twists >360° on its vascular pedicle. This may obstruct venous and arterial blood flow, resulting in testicular edema, ischemia, infarction, atrophy, and loss of function, depending upon the extent of vascular compromise [3, 4]. There are two variants of testicular torsion. Extravaginal torsion occurs in fetuses and neonates, when incomplete fusion of the tunica vaginalis to the scrotal wall allows twisting of the entire contents of the tunica [5, 6]. Intravaginal torsion, on the other hand, affects older children or adults with improper fixation of the testicle, including either an elongated mesorchium, or incomplete investiture by the tunica vaginalis, which is commonly referred to as the “Bell-Clapper” deformity [7]. Of note, the predisposing anatomy is bilateral in over two-thirds of patients [7], placing the contralateral testicle at risk of torsion as well.