This is an excellent review of ‘testicular’ torsion - which is said to occur in 1:4000 under 25-year-olds. Two age periods (adolescence and neonatal) are identified as having peak incidence. Acute torsion represents 27% of children with acute scrotum. The differentiation between intravaginal and extravaginal torsion is well made. Investigations discussed in detail include ultrasonography, scrotal scintigraphy, contrast enhanced ultrasound, perfusion computed tomography (CT), dynamic contrast enhanced magnetic resonance imaging (MRI) and near infrared spectrography although none are said to sufficiently replace the old fashioned history taking and examination and don’t prevent surgery in many cases (the old adage “if in doubt, operate” still holds strong). In terms of fixation, three-point fixation with non-absorbable sutures is mentioned but the recommendation is that eversion of the tunica and dartos pouch fixation is probably better at preventing recurrent torsion, which is a well-known entity. Contralateral exploration in a bell clapper deformity is mandatory. There is not enough evidence to use adjunctive measures to influence ischaemic-reperfusion injury after de-rotation. There is a good discussion of perinatal torsion and bilateral exploration of all cases of perinatal torsion is recommended. All patients with undescended testes and abdominal pain should have an inguinal torsion as part of the differential diagnosis. 

Torsion of spermatic cord in children: A review.
Drlík M, Kočvara R.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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