CRCM  Vol.2 No.1 , March 2013
Perinatal testicular torsion—An emergency with grave consequences
ABSTRACT

Introduction: Perinatal testicular torsion is not a frequent, but a grave finding finding. As only immediate surgical retorsion may save the viability of the testicle, time is of essence. We report the case of a newborn where delayed diagnosis led to an unnecessary loss of one testicle. Presentation of Case: The newborn was presented one day after delivery with a swollen left blue scrotal pouch. The left testicle was little tender, higher in position and enlarged. Ultrasound revealed a globular, enlarged testicle left, showing hypodense necrotic areas within. Doppler sound could not detect any perfusion of the spermatic vessels. Scrotal fluid was present bilaterally. At operation, the testicle was considered unsalvageable, and left orchiectomy and right orchidopexy were performed. Discussion: In the new-born, it is more than convenient to perfom ultrasound of both testicles at the same time, which allows to compare texture and perfusion easily. Immediate surgical exploration should be performed at any time, even if in diagnostic doubt. The very most important step though is to professionally recognise and to react to this pediatric emergency, as time is of paramount essence. Conclusion: A case of a male newborn with unilateral perinatal testicular torsion is presented, where typical clinical signs and ultrasound features can be seen. Early exploration with orchiectomy of the necrotic testicle and orchidopexy of the healthy side may save the endocrine function and fertility.


Cite this paper
Doll, D. , Erkel, J. , Erhart, T. and Hönemann, C. (2013) Perinatal testicular torsion—An emergency with grave consequences. Case Reports in Clinical Medicine, 2, 66-69. doi: 10.4236/crcm.2013.21019.
References
[1]   Archambeault, D.R., Tomaszewski, J., Joseph, A., Hinton, B.T. and Yao, H.H. (2009) Epithelial-mesenchymal crosstalk in Wolffian duct and fetal testis cord development. Genesis, 47, 40-48. doi:10.1002/dvg.20453

[2]   Vinci, G., Anjot, M.N., Trivin, C., Lottmann, H., Brauner, R. and McElreavey, K. (2004) An analysis of the genetic factors involved in testicular descent in a cohort of 14 male patients with anorchia. The Journal of Clinical Endocrinology & Metabolism, 89, 6282-6285. doi:10.1210/jc.2004-0891

[3]   Ahmed, S.J., Kaplan, G.W. and DeCambre, M.E. (2008) Perinatal testicular torsion: Preoperative radiological findings and the argument for urgent surgical exploration. Journal of Pediatric Surgery, 43, 1563-1565. doi:10.1016/j.jpedsurg.2008.03.056

[4]   Baptist, E.C. and Amin, P.V. (1996) Perinatal testicular torsion and the hard testicle. Journal of Perinatology, 16, 67-68.

[5]   Gorbonos, A. and Cheng, E.Y. (2007) Perinatal testicular torsion in siblings. Journal of Pediatric Urology, 3, 514515. doi:10.1016/j.jpurol.2007.04.009

[6]   Orazi, C., Schingo, P., Ferro, F., Vacca, P., Spagnoli, A. and Fariello, G. (1997) Does B-mode ultrasound still have a role in the diagnosis of spermatic cord torsion? Findings in a pediatric series. Radiologia Medica, 94, 646-651.

[7]   Campbell, J.R. and Schneider, C.P. (1976) Intrauterine torsion of an intra-abdominal testis. Pediatrics, 57, 262-264.

[8]   Ching, C.B. and Jones, J.S. (2011) Incomplete prenatal torsion of the testicle-A successful salvage. Urology, 78, 1182-1184. doi:10.1016/j.urology.2011.02.021

[9]   Roth, C.C., Mingin, G.C. and Ortenberg, J. (2011) Salvage of bilateral asynchronous perinatal testicular torsion. Journal of Urology, 185, 2464-2468. doi:10.1016/j.juro.2011.01.013

[10]   Arena, F., Nicotina, P.A., Scalfari, G., Visalli, C., Arena, S., Zuccarello, B. and Romeo, G. (2005) A case of bilateral prenatal testicular torsion: Ultrasonographic features, histopathological findings and management. Journal of Pediatric Urology, 1, 369-372. doi:10.1016/j.jpurol.2005.03.001

[11]   Bagci, S., Bachour, H., Woelfle, J.F., Mueller, A., Bartmann, P. and Franz, A.R. (2010) Bilateral perinatal testicular torsion in an infant: a rare neonatal emergency. Pediatrics International, 52, e227-e228. doi:10.1111/j.1442-200X.2010.03139.x

[12]   Olguner, M., Akgur, F.M., Aktug, T. and Derebek, E. (2000) Bilateral asynchronous perinatal testicular torsion: A case report. Journal of Pediatric Surgery, 35, 13481349 doi:10.1053/jpsu.2000.9330

[13]   Zampieri, N., Cecchetto, M., Ottolenghi, A. and Camoglio, F.S. (2009) Bilateral testicular torsion: An extremely tragic rare condition. Minerva Pediatrica, 61, 455-457.

[14]   Calonge, W.M., Heitor, F., Castro, L.P., Meruje, M., Coutinho, S.P., Cunha, C. and de Ochoa, C.A. (2004) Neonatal paratesticular neuroblastoma misdiagnosed as in utero torsion of testis. Journal of Pediatric Hematology/Oncology, 26, 693-695. doi:10.1097/01.mph.0000141896.97372.ce

[15]   Nitzsche, K., Kamin, G., Dittert, D.D., Bier, A. and Distler, W. (2009) Fetal juvenile granulosa cell tumor with hermaphroditism verus prenatal diagnosis, management and outcome. Ultraschall in Der Medizin, 30, 404-407. doi:10.1055/s-2007-963556

[16]   Cesca, E., Midrio, P., Tregnaghi, A., Alaggio, R., Bitetti, S. and Gamba, P. (2009) Meconium periorchitis: A rare cause of fetal scrotal cyst—MRI and pathologic appearance. Fetal Diagnosis and Therapy, 26, 38-40. doi:10.1159/000236358

[17]   Brown, S.M., Casillas, V.J., Montalvo, B.M. and AlboresSaavedra, J. (1990) Intrauterine spermatic cord torsion in the newborn: Sonographic and pathologic correlation. Radiology, 177, 755-757.

[18]   Burks, D.D., Markey, B.J., Burkhard, T.K., Balsara, Z.N., Haluszka, M.M. and Canning, D.A. (1990) Suspected testicular torsion and ischemia: Evaluation with color Doppler sonography. Radiology, 175, 815-821.

[19]   O’Hara, S.M., Frush, D.P., Babcock, D.S., Lewis, A.G., Barr, L.L., Bukowski, T.P., Kline-Fath, B.M. and Sheldon, C.A. (1996) Doppler contrast sonography for detecting reduced perfusion in experimental ischemia of prepubertal rabbit testes. Academic Radiology, 3, 319-324. doi:10.1016/S1076-6332(96)80249-2

[20]   Van, G.E., Philippe-Chomette, P., Gall, O., Oro, H., Larroquet, M. and Audry, G. (2000) Spermatic cord torsion in the newborn: Role of surgical exploration. Archives of Pediatrics, 7, 1072-1076. doi:10.1016/S0929-693X(00)00315-8

 
 
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