Image Based Question – 72029

Regarding this condition shown in the image,which of the following statement is false?

A. Inversion of the testis is the most common predisposing cause

B. Pyuria may be present

C. Doppler U/S shows decreased blood flow to the testis

D. Simultaneous orchipexy of the other side should also be done.

Show Answer

Correct Answer » B Explanation

Ans:B. Pyuria may be present

Torsion of the testis is shown in the image

TORSION OF THE TESTIS

• For torsion to occur one of the several abnormalities must be present

• Inversion of the testis is the most common predisposing cause

• High investment of tunica vaginalis (testis hangs like clapper in bell).

Predisposing factors

• Bell-clapper deformity—poor gubernacular fixation of the testicles to the scrotal wall

• Straining at stool

• Lifting heavy weight

• Coitus

• Sometimes spontaneously during sleep

Clinical features

• Most common between 10 and 25 years of age. Few cases occur in infancy

• Most common cause of testicular pain >12 years

• Sudden agonizing pain in the groin and lower abdomen, nausea, vomiting.

• Pyuria is associated with epidydimo-orchitis, not with torsion of testis

• Deming’s sign: affected testis is positioned high because of twisting of cord and spasm of cremaster muscle

• Angell’s sign; Opposite testis lies horizontally because of presence of mesorchium

• Prehn’s sign: on elevation of testis

• Pain decreases epididymorchitis

• Pain increases torsion

• Doppler ultrasound scan will confirm the absence of blood supply to the affected testis. But if diagnosis is doubt, the scrotum should be explored without delay.

Management :

• If the diagnosis of testicular torsion is possible, then surgical exploration is indicated

• Prompt exploration, untwisting and fixation is the only way to save the torted testis

• Anatomical abnormality is bilateral and the contralateral testis should also be fixed