Testicular torsion: The unexpected terrible twos, a unique case report

Abstract

Introduction: Testicular torsion is a common pediatric urologic emergency that affects 3.8 per 100,000 males younger than 18 yrs annually. The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty. Herein, we describe a case report involving testicular torsion in a rarely seen age group. Case presentation: A 2 year old male with no past medical history presented to the Emergency Department with left testicular pain and swelling. His physical exam revealed a well-developed child in mild distress related to discomfort. The left testis appeared edematous and erythematous. It was firm and tender to palpation. The ultrasound with Doppler of the left testis revealed marked tunica thickening and hyperemia with overlying scrotal edema and hyperemia. The patient was taken emergently to the operating room for exploration. There was torsion of the left spermatic cord within the tunica vaginalis with a necrotic testis. A left orchiectomy and right orchiopexy were performed. Conclusion: When dealing with acute scrotal etiologies one must consider a broad differential diagnosis including testicular torsion, incarcerated or strangulated inguinal hernia, trauma and epididymitis. This case report demonstrates a unique presentation of testicular torsion in an unexpected age group. Keywords: Testicular torsion, Urologic emergency