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Journal of Indian Association of Pediatric Surgeons
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LETTERS TO THE EDITOR
Year : 2021  |  Volume : 26  |  Issue : 1  |  Page : 68
 

Let's not Clinically Miss Testicular Torsion in Patients Presenting with Lower Abdominal Pain and Vomiting


Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India

Date of Submission15-Jul-2020
Date of Decision05-Sep-2020
Date of Acceptance16-Sep-2020
Date of Web Publication11-Jan-2021

Correspondence Address:
Dr. Pankaj N Maheshwari
Department of Urology, Fortis Hospital Mulund, Mulund-West, Mumbai - 400 078, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_262_20

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How to cite this article:
Maheshwari PN, Arora AM. Let's not Clinically Miss Testicular Torsion in Patients Presenting with Lower Abdominal Pain and Vomiting. J Indian Assoc Pediatr Surg 2021;26:68

How to cite this URL:
Maheshwari PN, Arora AM. Let's not Clinically Miss Testicular Torsion in Patients Presenting with Lower Abdominal Pain and Vomiting. J Indian Assoc Pediatr Surg [serial online] 2021 [cited 2021 Jan 23];26:68. Available from: https://www.jiaps.com/text.asp?2021/26/1/68/306703




Sir,

Recently, three young boys lost a testis as the surgical management for the torsion testis got delayed due to their atypical presentation and missed clinical findings.

Testicular torsion is the most common urological emergency in children, and most boys present with acute-onset scrotal pain with swelling. Early diagnosis and prompt surgical de-torsion with orchiopexy is extremely important for testicular salvage. Even after testicular salvage procedures, 41.4% of the patients can eventually experience testicular atrophy.[1] Obviously, timely testis-preserving surgery tends to better maintain testicular function than orchiectomy.[2] It also helps the child to maintain his self-confidence and a positive body image.

All the three boys (age range: 6–13 years) presented to their primary care pediatrician with acute-onset abdominal pain and vomiting. None of them had any scrotal pain or swelling. Without clinical examination of the scrotum, they were treated medically for their abdominal symptoms, leading to a significant delay in the diagnosis of torsion. Timely clinical examination could have led to prompt diagnosis and probably testicular salvage, but the average delay in diagnosis was 4.66 days. The torsion was diagnosed on the 3rd, 4th, and 7th day. Orchiectomy with opposite-side orchiopexy was needed in all the three cases.

Such atypical presentation is reported in literature, and nearly 12% of children can present only with abdominal pain.[3] The exact pathophysiology of testicular torsion presenting with abdominal pain is not clear. It could be related to a common innervation between the scrotum (L1 in the anterior part and S2 and S3 in its posterior part), testis, and abdominal organs. The cause could just be mechanical when the twisted spermatic cord or the tensed cremaster muscle pulls and stimulates the peritoneum.[3] The risk of testicular loss is very high if there is delay in the initial diagnosis of testicular torsion.[4] The loss of one testis may not significantly impact later paternity or erectile function, but it surely impacts the child's body image and self-confidence.[5]

Taking an effort to examine the scrotum of every child presenting with abdominal pain is very important. Concerted efforts are needed in educating the primary care and the emergency department physician the importance of clinical examination of scrotum in every child presenting with acute abdomen. This would not only help prevent testicular loss but also reduce the chance of medicolegal implications for the treating clinician.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Meng H, Mujie L, Zhang W. Prognosis of testicular torsion orchipexy. Andrologia. 2020;52:e13477.  Back to cited text no. 1
    
2.
Taskinen S, Makela E, Raivio T. Effect of pediatric testicular torsion on testicular function in the short term. J Pediatr Surg 2019;S0022-3468:30758-4.  Back to cited text no. 2
    
3.
Wang F, Mo Z. Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males. Asian J Urol 2019;6:368-72.  Back to cited text no. 3
    
4.
Kumar V, Matai P, Prabhu SP, Sundeep PT. Testicular loss in children due to incorrect early diagnosis of torsion. Clin Pediatr (Phila) 2020;59:436-8.  Back to cited text no. 4
    
5.
Makela EP, Roine RP, Taskinen S. Paternity, erectile function, and health-related quality of life in patients operated for pediatric testicular torsion. J Pediatr Urol 2020;16:44.e1-44.e4.  Back to cited text no. 5
    




 

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