A painful turn of events
Testicular torsion is a surgical emergency. Irreversible ischaemia occurs at six hours if it is untreated,1 ultimately resulting in loss of the testicle. Definitive treatment requires urgent surgical exploration, detorsion, and fixation of both testes within the scrotum (bilateral three point orchidopexy). A clinical diagnosis of testicular torsion can, however, be challenging, even for the experienced clinician. The two main differential diagnoses, torsion of the appendix testis (or hydatid of Morgagni) and acute epididymo-orchitis, can both present in an identical manner, though their management is more conservative.
Testicular torsion occurs in about 1 in 4000 men and boys under 25 years, peaking during the neonatal period and around 13 years of age (a bimodal age distribution).1 Despite isolated reports of testicular torsion in men over the age of 50 years, it is rarely seen in those over the age of 30.
Around 90% of cases are thought to arise from