Pediatric emergency medicine trisk 1177 1177

FIGURE 61.4 Torsion of testis Ultrasound reveals enlarged right testicle and Doppler flow demonstrates no flow to necrotic testis The treatment of testicular torsion is surgical exploration, detorsion, and fixation (orchiopexy) of the torsed and contralateral testis A nonviable testis requires orchiectomy and fixation of the contralateral testis If a testis has been twisted sufficiently to fully obstruct its blood supply for more than to 12 hours, surgical detorsion is unlikely to salvage the gonad Salvage rates are 90% to 100% within hours of symptom onset, 50% beyond 12 hours, and 10% when beyond 24 hours However, it is impossible to determine clinically whether the torsion has been partial or total, so regardless of the estimated duration of torsion immediate surgical intervention is required If a child is seen within a few hours of the onset of his torsion, before severe scrotal swelling has ensued, manual detorsion of the spermatic cord to restore blood supply to the testis can be considered Ideally, this is undertaken by a physician experienced with the technique when surgery is not an immediate option Sedation and analgesia should be administered Doppler stethoscope or color Doppler ultrasound should be used to confirm the return of normal arterial pulsations to the testis Since torsion typically (in two-thirds of cases) occurs in a medial direction, detorsion should initially be carried out by rotating the testis