Do not forget to include testicular torsion in differential diagnosis of lower acute abdominal pain in young males

Abstract

Background: Management and outcomes of pediatric patients with testicular torsion initially presenting as acute abdominal pain were evaluated.

Patients and methods: The case records of 84 children operated on for testicular torsion from January 1999 through May 2012 were retrospectively reviewed. Of the total number of operated patients, 9 presented with abdominal pain but without initial scrotal pain, and only they were included in the study. The diagnosis of testicular torsion was made clinically and confirmed by Doppler ultrasound and scrotal exploration.

Results: The most common presenting symptoms were abdominal pain and vomiting. The patient's scrotum and testicles were not examined during the first evaluation in 6 cases, while in 3 cases the testicles were examined during the first physical examination. At surgery, 4 testes were salvaged, while 5 have been lost because of testicular necrosis. The mean duration of symptoms was 4 h in the group of salvaged testes and 39 h in the orchidectomy group. There were no major complications.

Conclusion: Testicular torsion should always be included in differential diagnosis when evaluating lower abdominal pain in young males. The external genital organs should be examined in every child or adolescent with acute abdominal pain.

Keywords: Abdominal pain; Acute scrotum; Children; Spermatic cord torsion; Testicular torsion.