A Rare Case of Testicular Torsion in a 75 Year Old

Abstract

Background: Testicular torsion occurs when a testicle torts on the spermatic cord resulting in the cutting off of blood supply. The most common symptom is acute testicular pain and the most common underlying cause, a bell-clapper deformity. Testicular torsion implies obstruction of first venous, and later, arterial flow. The extent of testicular ischemia will depend on the degree of twisting (180°-720°) and the duration of the torsion. Testicular salvage is more likely in patients treated within 4-6 hours after the onset of torsion. Case Presentation: We came across an unusual case of testicular torsion in a 75 years old man,who presented to our emergency department with a 7 days history of right-sided testicular pain with no pyrexia,urinary symptoms and negative urine routine ,initially treated with antibiotics elsewhere as torsion amongst the elderly population is rarely described. This case presents the oldest surgically confirmed case of testicular torsion, in a 75-year-old male, documented in a journal so far .There was no pyrexia or urinary symptoms and negative urine routine. In adults above the age of 40, likely diagnoses include epididymo-orchitis, epididymitis, neoplasm or hydrocele. Clinical differentiation with epididymo-orchitis can be difficult in any age range. Clinical signs such as fever, elevated C-reactive protein and positive urine test are suggestive of epididymo-orchitis/orchitis. Conclusion: This case study demonstrates that testicular torsion can occur at any age, and clinical suspicion should always be high in patients presenting with testicular pain and a negative urine tests, regardless of age. Although risk in this subgroup is low, the identification of a potentially reversible testicular abnormality should be of high priority.