ABSTRACT
Torsion of the spermatic cord is a surgical emergency caused by twisting and impedance of arterial blood flow to the testicle.
There are two types of testicular torsion: extravaginal, which occurs in neonates; intravaginal, which typically occurs in adolescents.
Intravaginal torsion presents as acute onset of testicular pain. Exam may show high-riding testis with transverse lie, absence of cremasteric reflex, and continued pain despite scrotal elevation.
Diagnosis should be based primarily on history and physical exam. Scrotal ultrasound with color Doppler flow may aid diagnosis.
Treatment is scrotal exploration with detorsion of the affected testicle. If the testicle is necrotic, it is excised. If it is viable, it is secured in place. The contralateral testicle is also explored and secured in place.
