Misdiagnosis of spermatic cord torsion resulting in testicular

necrosis in preteenagers-A report of three cases and review of literature.

Nilotpal Chakma, Pradip Sarkar, Sumit Gupta

Authors:

  1. Assistant Professor,Department of Surgery, AGMC G B Pant Hospital, Agartala,Tripura.
  1. Associate Professor, Department of Surgery , AGMC &G B Pant Hospital, Agartala , Tripura,
  1. Resident, Department of Surgery, AGMC & G B Pant Hospital, Agartala,Tripura.

Address for correspondence:

Dr Nilotpal Chakma, MBBS, MS(General Surgery),

H.No-60,Mission Compound, A.D Nagar, Agartala, West Tripura.Pin:799003.

Email:

Mobile No-09862193319.

ABSTRACT

We present here our experience with three cases of spermatic cord torsion withtesticular and epididymal necrosis due to misdiagnosis presenting in preteenagers inwinter season. This report denotes the importance of early presentation, correct diagnosis and prompt appropriate intervention in case of spermatic cord torsion to prevent loss ofaffected testis.

Key Words : Spermatic cord torsion, testicular necrosis, epididymal necrosis,preteenagers.

INTRODUCTION

Spermatic cord torsion with reduction or cessation of bood flow to the testis may occur insusceptible individuals. Two types of torsion described in the literature. Intravaginalspermatic cord ( testicular ) torsion occurs when the testis twists within the tunicavaginalis, whereas extravaginal testicular torsion occurs in the perinatal period beforefixation of the tunica vaginalis within the scrotum [1].We present here our experiencewiththree cases of spermatic cord torsion with testicular and epididymal necrosis due tomisdiagnosis presenting in preteenagers in winter season.

CASES REPORT

During a one month period (Mid-November to Mid- December 2012), three male

Preteenagers(9-12years) presented in A.G.M.C & G.B.P.H, Agartala after two days of onset of symptoms of severe pain in the left lower abdomen, accompanied with nausea . They were misdiagnosed , one case as intestinal colic & other two cases as ureteric colic at different primary health centres. When they presented to emergency department all of them had red, swollen [Fig-1] & tender left hemiscrotum and absence of cremasteric reflex. Ultrasound with colour Doppler study revealed thickenend spermatic cord with absent blood flow in the left testis.All the three cases were managed with high orchidectomy with right orchidopexy as surgicalexploration of the left hemiscrotum revealed necrosed & nonviable testis, epididymis and spermatic cord due to twists in the spermatic cord [Fig-2].

Fig-1. Red,swollen left hemiscrotum at presentation

Fig-2. Intra-op. picture of same patient showing necrosed, nonviable left spermatic cord & testis following torsion

DISCUSSION

Torsion of spermatic cord can occur in males of all ages including infants [2]. It is more frequently seen among adolescents with about 65% of cases presenting between 12-18years of age [3].Torsion of spermatic cord occurs due to presence of some predisposing factors viz. bell-clapper deformity of the testis, undescended testis, cold temperature, sudden movement or trauma with activation of cremasteric reflex or rapid growth of the testes at puberty[1] . Strangulation of the spermatic cord by torsion on its long axis may interfere sufficiently with vascularization so as to produce a sephacelous condition in the cord itself, in the testicle , or in both. The condition probably occurs with much greater frequency than a perusal of the literature would suggest ; but owing to its simulating other conditions the correct diagnosis is often not made unless operation is carried out [4]. All the three cases presented to this institute were delayed because of misdiagnosis at the primary health care centres where specialist are not available. So it is concluded that early presentation, correct diagnosis and prompt appropriate intervention are the keys to salvage the affected testis.

REFERENCES

  1. Barthold JS. Campbell-Walsh Urology: Abnormalities of the testis and scrotum and theirsurgical management. 10th ed. Philadelphia: Saunders ; 2012 ; 132 : 3557-96.
  1. Uribe, Juan F.Genitourinary pain and inflammation: diagnosis and management.Totowa, New Jersey:2008: Humana.ISBN978-1-58829-816-4.
  1. Edelsberg JS, Surh YS . "The acute scrotum".Emerg. Med. Clin. North Am.1988 August; 6(3): 521–46.
  1. Thorek M. Torsion of the spermatic cord. Report of two cases with review of literature. Ann. Surg.1925 June ; 81(6) : 1142-9.

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