Left testicular pain, nausea and vomiting, secondary to testicular torsion
This article describes the case of testicular torsion in a 16-year-old boy. He presented to the emergency with a 2-day history of left testicular pain, nausea and vomiting. His medical history did not show any clinically significant findings and belonged to a remote area of India. According to the patient, the pain suddenly developed while taking a bath.
Physical examination showed an erythema on the left side of the scrotum. In addition, the left testicle was tender on palpation and elevated in comparison to the right testicle. The cremasteric reflex was also absent on the left side. The cremasteric reflex is a superficial reflex that is elicited in human males on stroking the inner part of the thigh. Stroking causes the cremaster muscle to contract and the ipsilateral testicle pulls up towards the inguinal canal.
The patient was immediately taken to the operating room for an emergency scrotal exploration
Gross examination showed that the left testicle was black with 1080 degrees of spermatic cord rotation. There was no sign of bell clapper deformity, an abnormal tunica vaginalis attachment that increases testicular mobility. However, despite prompt detorsion of the testis, the patient showed no improvement. Doctors further performed a left orchiectomy and right orchiopexy. An incision was also made in the tunica albuginea (a fibrous envelope extending to the penis) yielded no blood. After the procedures, the patient’s pain and swelling subsided and he was discharged after 2 days.
Testicular torsion is an emergency condition in which the tissues around the testicle are not attached well. This results in the testes twisting around the spermatic chord. Similarly, when this happens the blood flow around the testicles is cut off, causing pain and swelling. Normally the testes are organs that hang in a pouch of skin known as the scrotum. The blood supply for the testicles comes from the spermatic cord.
Source: NEJM
