RESUMO
Objective To evaluate the characteristics of the testicular torsion patients with the first symptom of acute abdominal pain.Methods From October 1998 to May 2014, 8 adolescent or boys with testicular torsion presenting acute abdominal pain instead of scrotal pain as their primary symptom were retrospectively reviewed.The average age was 12 (3-16) years.An acute abdominal pain presented firstly in all cases, which accompanied by nausea and vomiting in 4 cases, groin pain in 2 cases, fever in 1 case. In genital examination, the scrotum skin was red and swollen, while the testis was in transverse position and tenderness.The testicular and homolateral abdominal pain got worse when we pulled the involved testis. Doppler ultrasound examination revealed that the blood supply of the involved testis decreased or disappeared.Results In the 8 cases, 5 cases were not examined their testicles or scrotum during the first evaluation, which were found the testicular necrosis during the following exploratory surgery, and orchidectomy was performed. In the other 3 cases, external genital were examined during the first evaluation, and the scrotal and testicular abnormalities were detected.Doppler ultrasonography showed abnormality in testicular blood supply.Testicular torsion was proved during the emergent operation, and the 3 testes were salvaged.The mean duration time from symptom onset to operation was 4 h in the salvaged group, while the average time was 28 h in the orchiectomy group.The mean follow-up time was 18 ( 10-36) months.In the 3 cases whose testis was saved, 1 affected testis was atrophied, and the blood supply of the other two was good.No severe complications occurred in the other 5 cases.Conclusions Testicular torsion should be considered in adolescents and boys with acute lower abdominal pain.The routine external genital examination should be performed when a boy or adolescent complains of abdominal pain.
RESUMO
PURPOSE: Acute scrotal pain is one of the most alarming urologic symptoms, concealing testicular inflammation, testicular torsion, torsion of testicular appendix and a variety of miscellaneous diseases. Even with careful physical examination with recently developed diagnostic equipments, a reliable diagnosis may not be achieved in a significant number of patients. In these cases an operation is necessary for exclusion of testicular torsion. MATERIALS AND METHODS: Between 1991 and 1998, we reviewed 17 patients diagnosed as having torsion of testicular appenix, whose ages varied from 3 years to 15 years during recent 8 years. RESULTS: 16 cases out of seventeen patients(94%) were younger 12 years and prevalent age was 11 years(6/17). The average interval that elapsed from onset of symptoms until the patient was seen for the first time on the hospital was 64 hours, with a range varying from three hours to seven days. The most frequently observed symptoms and signs were diffuse scrotal pain, swelling and erythema of the affected scrotum. The explorative scrototomy were performed in 16 cases out of 17 patients who had appendix testis torsion, and the 1 case had conservative treatment after getting confirmative diagnosis by ultrasonography. The scrotal pain disappeared mostly within 1 day after operation, and the complications didn`t happen. CONCLUSIONS: There is controversy as whether the majority of children with torsion of the testicular appendix develop sufficiently grave symptoms to justify the surgical exploration. For this reason, once a diagnosis of torsion of the spermatic cord is ruled out, some investigators prefer conservative treatment. However, differential diagnosis with torsion of the spermatic cord is difficult and acute scrotal pain disappear within 24hours after excision of the twisted appendix. Therefore, we are in favor of surgical treatment.