Testicular Torsion Masked by Painful Abdomen
We would like to add a few comments to the excellent review article by Günther and Rübben. In our opinion it seems worth mentioning that testicular torsion may be masked by a painful abdomen. We review 10 patients with testicular torsion who presented with abdominal pain as their leading symptom. For this reason we recommend mandatory genital examination in the clinical assessment of boys with abdominal pain. Particular attention should go to boys with reduced sensitivity of the lower half of the body—for example, in patients with meningomyelocele.
When operating a patient with an incarcerated inguinal hernia we advise to visualize the ipsilateral testis since an incarceration can substantially compromise testis perfusion.
Testicular trauma is not only an important differential diagnosis in acute scrotum but in itself presents a risk factor for testicular torsion (e21 in the article).
The literature encompasses some 50 cases of ipsilateral testicular torsion after orchidopexy (1). Thus we suggest the modified technique for testicular fixation reported by Gesino and Bachmann de Santos (2).
A full blood count, C-reactive protein concentration, and the analysis of urine sediment are listed as components of the diagnostic approach. With the exception of leukemia, which hardly ever needs to be considered, none of the differential diagnoses has a definitive laboratory constellation. Studies investigating predictive variables in acute pediatric scrotum mostly do not even consider laboratory variables from the outset (for example, e21 and 3). Furthermore, ascertaining the above-mentioned parameters may delay the definitive diagnosis. The decisive issue is timely presentation in institutions that can perform the required surgical measures immediately. For this reason we think that the diagnostic evaluation listed above can be dispensed when assessing a boy for testicular torsion.
Dr. med. Mariana Santos
Dr. med. Michael Kohl
Funktionsbereich Kinderchirurgie der Klinik für Allgemein-,
Viszeral- und Kinderchirurgie, Uniklinik Düsseldorf
|1.||von Zastrow C, Sotelino JA: Wiederauftretende Hodentorsionen. Kann ein pexierter Hoden torquieren? Urologe 2005; 44: 1337–40. CrossRef MEDLINE|
|2.||Gesino A, Bachmann De Santos ME: Spermatic cord torsion after testicular fixation. A different surgical approach and a revision of current techniques. Eur J Pediatr Surg 2001; 11: 404–10. CrossRef MEDLINE|
|3.||Boettcher M, Bergholz R, Krebs TF, Wenke K, Aronson DC: Clinical predictors of testicular torsion in children. Urology 2012; 79: 670–4. CrossRef MEDLINE|
|4.||Günther P, Rübben I: The acute scrotum in childhood and adolescence. Dtsch Artzebl Int 2012; 109(25): 449–58. VOLLTEXT|