Torsion of an Undescended Testis — A Surgical Pediatric Emergency
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Read the article on jpedsurg.org ↗Article · Jul 2019 · 1 min read
In brief
In brief
Retrospective study of 11 infants with torsion of undescended testes shows this accounts for nearly 10% of all testicular torsions, often misdiagnosed as inguinal hernia. Mean presentation age was 9.4 months with delayed diagnosis leading to only 18% testicular salvage rate, emphasizing need for high clinical suspicion and urgent surgical intervention in boys with cryptorchidism presenting with groin masses.
Written by the GCMD Library team from the article.
Background/Purpose
Torsion of an undescended testis is a surgical emergency whose frequency may be underestimated in the pediatric population. We describe this entity and focus on diagnostic challenges and optimal treatment of torsion of an undescended testis.
Methods
We present a two-center retrospective chart review of patients with torsion of an undescended testis treated between 2013 and 2018. Two instructive cases are used to depict characteristics of this rare entity.
Results
We identified 11 patients with previously diagnosed cryptorchidism undergoing surgery for torsion of an undescended testis, accounting for 9.7% (11/107) of all testicular torsions in the period. Mean age at diagnosis was 9.4 months (1–22 months). Mean duration from onset of symptoms to presentation was 19.3 h (8–48 h). At admission to hospital 10 patients presented with groin lump (10/11, 90.9%) with or without pain leading to a suspected diagnosis of inguinal testicular torsion (5/11, 45.5%), incarcerated inguinal hernia (4/11, 36.4%) and epididymitis (1/11, 9.1%). Ten patients had an ultrasound examination before surgery leading to the correct diagnosis in six patients. Ultrasound findings were misinterpreted as incarcerated inguinal hernia in three patients. In eight patients the testis had to be removed at time of surgery; one of the three salvaged testes atrophied, resulting in a salvage rate of 18%.
Conclusion
Torsion of an inguinal testis is not as rare as it might be presumed. Presentation of these patients is often deferred owing to equivocal signs and symptoms. In addition age at presentation differs from typical testicular torsion. As this might negatively influence testicular salvage rate, we advocate for special attention to this differential diagnosis in children with groin pathologies. Even if the child is not in pain, a tender groin in boys with undescended testes must prompt a quick and thorough examination to rule out torsion of an undescended testis. Ultrasound examination is of limited value and must not delay acute surgical treatment.
Level of evidence
IV