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Torsion Of The Testis - Reaction After Hydrocelectomy

One of the acute surgical emergencies that can occur in children is a condition known as torsion of the testis. The ages of 12 and 18 are the years in which the incidence of torsion of the testis is at its highest.

Patients aged 12 to 18 years old accounted for 625 cases, while patients aged 21 and up accounted for 20% of the cases.

Torsion of the testicle is a relatively uncommon condition that affects males aged 1 to 25 years and has an annual incidence of 4.5 per 100,000.

What Is Torsion Of The Testis?

Testicular torsion is a condition in which the testis and spermatic cord twist or rotate abnormally, causing severe scrotal pain. Delasiauve first described testicular torsion in 1840, and Taylor first reported it in a newborn in 1897.

A hydrocele is an abnormal collection of serous fluid between the layers of the tunica vaginalis. In children, this is the most common cause of painless scrotal swelling.

There have been a few cases of testicular torsion in people who have congenital hydrocele. Testicular torsion following hydrocelectomy in an adult, on the other hand, has never been documented.

More About Testicular Torsion

Bilateral synchronous or metachronous testicular torsion has a 2% chance of occurring. Intravaginal torsion or extravaginal torsion are both possible.

Hydrocele, on the other hand, can be acquired or congenital. Acquired hydrocele affects 1% of adults, is mostly idiopathic, and 7 to 10% of the time is bilateral. Infection, tumors, filariasis, tuberculosis, and torsion are all potential causes of hydrocele.

Torsion of the testis following hydrocele surgery is not known to occur. It has yet to be documented. It's possible that the reason is that it's never happened before or that it's not reported because the outcome is negative.

The cause of the torsion after hydrocelectomy is unknown. Hydrocele surgery is a routine procedure that is generally considered safe, even in the hands of inexperienced surgeons. The removal of the romovac drain was even considered as a possibility for causing the testis to rotate. Within 6 hours of the torsion, irreversible ischemia sets in. This patient came to see us nearly 48 hours after the onset of acute scrotal pain, by which time the testis had already suffered infarction, necessitating orchiectomy.

We are reporting this case to share an unexpected complication that occurred after a routine procedure, and to emphasize the importance of being vigilant and thoughtful about the possibility of such an event occurring after a hydrocelectomy.

What Causes Testicular Torsion?

The majority of cases are caused by the bell clapper deformity, an anatomical abnormality that affects some males. The spermatic cord can twist more easily due to this anatomical condition, compromising the blood supply to the testicle. This can happen on its own or be linked to a traumatic experience. There is no way to detect this deformity. This anatomical abnormality is found in both testicles in a large percentage of men.

What Are The Signs And Symptoms Of Testicular Torsion?

Excruciating one-sided testicular pain with sudden swelling is a symptom of testicular torsion. The testicle elevates due to the twisting of the cord structures (like the strings of a puppet). Patients may have nausea and vomiting. Patients may also have abdominal pain. It's possible that you've had previous testicular pain. The pain in the testicles may be accompanied by a fever.

Testicular torsion is most common in men between the ages of 12 and 18, with the majority of cases occurring in men under the age of 30. It can, however, happen at any age, even in newborns.

What Are The Exams And Tests To Diagnose Testicular Torsion?

A painful scrotum with one-sided testicular swelling and elevation is seen on a typical physical exam of a torn testicle. A urinalysis and blood count are two common lab tests. One or more radiologic studies could be used to image the scrotum. A Doppler ultrasound of the testicles or a nuclear scan of the testicles may be used to determine the degree of blood flow. Imaging may not be performed depending on the physical exam and/or time frame, as immediate treatment is required to save the testicle.

A Case Report

A 44-year-old man had been suffering from bilateral scrotal swelling for more than 5 years when he came to see us. He had excision and eversion of the sac after being diagnosed with bilateral primary vaginal hydrocele. The patient was comfortable on postoperative day 1. He was discharged after his drain had been removed. He had severe pain and swelling in his right scrotum three days after surgery. The patient was self-medicating and came to see us on the fifth day with severe scrotal pain, swelling, and a fever.

The right side of the scrotum was swollen and red at the time of the examination. There was a rise in temperature and tenderness in the area. His testis could not be felt. The left testis was palpated and found to be unresponsive. Suture lines appeared to be in good condition.

A scrotal ultrasound was performed immediately, which revealed an avascular right testis with diffuse scrotal oedema and enlarged testis. The left testis appeared to be normal.

An emergency scrotal exploration was performed on the patient while he was sedated. Torsioned testicles were avascular and gangrenous. He underwent a right orchiectomy. The patient refused to have a left orchiopexy performed.

A fully labeled testis on a white background
A fully labeled testis on a white background

People Also Ask

What Is The Most Serious Complication Of Testicular Torsion?

When testicular torsion is not treated for several hours, the testicle can suffer permanent damage due to blocked blood flow. It is necessary to remove the testicle surgically if it is severely damaged.

Can Hydrocele Cause Testicular Torsion?

The mechanism behind hernia sac torsion or scrotal hydrocele is unknown. According to Shiraishi et al., these disorders may arise from a bell-clapper deformity, in which the hydrocele remains loose or has slight adhesion, allowing for torsion.

Can You Accidentally Get Testicular Torsion?

When the testicles twist as a result of an injury or accident, this is known as testicular torsion.

What Happens After Hydrocele Surgery?

For several days after your surgery, you may feel more tired than usual and experience mild groin pain. Your groin and scrotum may be swollen or bruised. This usually improves in two to three weeks. You should be able to return to work or school four to seven days after surgery.

Conclusion

Torsion of the testis following hydrocelectomy is a very rare complication that has never been reported. When a patient develops acute pain after hydrocelectomy, this rare occurrence should be considered. The testis undergoes complete gangrenous changes as a result of the delayed presentation, which necessitates orchiectomy.

About The Authors

Suleman Shah

Suleman Shah - Suleman Shah is a researcher and freelance writer. As a researcher, he has worked with MNS University of Agriculture, Multan (Pakistan) and Texas A & M University (USA). He regularly writes science articles and blogs for science news website immersse.com and open access publishers OA Publishing London and Scientific Times. He loves to keep himself updated on scientific developments and convert these developments into everyday language to update the readers about the developments in the scientific era. His primary research focus is Plant sciences, and he contributed to this field by publishing his research in scientific journals and presenting his work at many Conferences. Shah graduated from the University of Agriculture Faisalabad (Pakistan) and started his professional carrier with Jaffer Agro Services and later with the Agriculture Department of the Government of Pakistan. His research interest compelled and attracted him to proceed with his carrier in Plant sciences research. So, he started his Ph.D. in Soil Science at MNS University of Agriculture Multan (Pakistan). Later, he started working as a visiting scholar with Texas A&M University (USA). Shah’s experience with big Open Excess publishers like Springers, Frontiers, MDPI, etc., testified to his belief in Open Access as a barrier-removing mechanism between researchers and the readers of their research. Shah believes that Open Access is revolutionizing the publication process and benefitting research in all fields.

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