Jornal de Desenvolvimento de Drogas
Acesso livre

Abstrato

Bilateral synchronous intravaginal testicular torsion presenting with unilateral testicular pain

Muhesh Taheem

Abstract
Aims: We aim to present an atypical case of bilateral testicular torsion and discuss current standards of management and follow-up.

Case: An adolescent presented with a 5 hour of history of unilateral testicular pain and examination findings in keeping with a unilateral testicular torsion. On scrotal exploration there was evidence of bilateral testicular torsion and bilateral orchidopexy was performed. Follow-up ultrasound scan after 3 months demonstrated preserved vascularity and size of both testes.

Discussion: Intravaginal bilateral testicular torsion is a rare entity in adolescents and adults. Both unilateral and bilateral testicular torsions in adolescents are commonly associated with anatomical anomalies including the “bell-clapper deformity”, which was not present in this case. Despite warming the symptomatic testis for 40 minutes some clinical doubt about viability still remained. Guidelines are not clear about length of reperfusion period before consideration of orchiectomy. Follow-up with ultrasound is recommended after 6 months to assess testicular atrophy, but considerable variation in practice exists.

Conclusion: This is an atypical case of bilateral synchronous testicular torsion demonstrable by an absence of classical risk-factors, alongside unilateral clinical signs and symptoms. Lack of consensus regarding time allowed for reperfusion may result in orchiectomy where testicular salvage is possible.