ABSTRACT
A1 D Testicular torsion can occur at any age but it is the most common cause of acute scrotum at puberty. There is a second peak of incidence in infancy. The aetiology in this age group is different as the torsion is extravaginal. At puberty the torsion is intravaginal due to an abnormally high insertion of the tunica vaginalis. Typically torsion presents with acute onset of scrotal pain, often accompanied by nausea and vomiting. Early examination reveals a hard tender testicle, which may be lying high in the scrotum. The cord is often tender and the cremasteric reflex is absent. The overlying scrotum is of a normal appearance until late when inflammation, secondary to testicular necrosis, causes swelling and redness. Diagnosis is essentially clinical. While Doppler ultrasound can be helpful in postpubertal testicular torsion it is unreliable in younger children. Bilateral fixation is essential although the exact technique of doing this remains controversial, including whether to use permanent or dissolving sutures. In general the fixation should be at multiple points with the tunica everted.
