Pediatric emergency medicine trisk 1177 1177

FIGURE 61.4 Torsion of testis. Ultrasound reveals enlarged right testicle and Doppler flow
demonstrates no flow to necrotic testis.

The treatment of testicular torsion is surgical exploration, detorsion, and
fixation (orchiopexy) of the torsed and contralateral testis. A nonviable testis
requires orchiectomy and fixation of the contralateral testis. If a testis has been
twisted sufficiently to fully obstruct its blood supply for more than 6 to 12 hours,
surgical detorsion is unlikely to salvage the gonad. Salvage rates are 90% to
100% within 6 hours of symptom onset, 50% beyond 12 hours, and 10% when
beyond 24 hours. However, it is impossible to determine clinically whether the
torsion has been partial or total, so regardless of the estimated duration of torsion
immediate surgical intervention is required.
If a child is seen within a few hours of the onset of his torsion, before severe
scrotal swelling has ensued, manual detorsion of the spermatic cord to restore
blood supply to the testis can be considered. Ideally, this is undertaken by a
physician experienced with the technique when surgery is not an immediate
option. Sedation and analgesia should be administered. Doppler stethoscope or
color Doppler ultrasound should be used to confirm the return of normal arterial
pulsations to the testis. Since torsion typically (in two-thirds of cases) occurs in a
medial direction, detorsion should initially be carried out by rotating the testis