Abstract
Perinatal testicular torsion is a relatively rare event that remains unidentified in many situations and managed only after an avoidable delay of time. Its current management approaches include watchful observation, delayed contralateral orchiopexy, and emergent contralateral orchiopexy. On the other hand, bilateral torsion is now being more frequently reported. However, the assessment of the contralateral testis through physical examination and imaging can be inaccurate in cases of perinatal torsion. We report a case of prenatal testicular torsion with incidentally discovered metachronous contralateral extravaginal testicular torsion. Therefore, immediate surgical intervention is recommended both when uni- or bilateral testicular torsion is suspected. Whenever possible, affected testes should be preserved as some endocrine function may be retained.
Highlights
Neonatal testicular torsion (NTT) was first described by Taylor et al in 1897 [1]
Right scrotal exploration was done through midline raphe incision and revealed right extra-vaginal testicular torsion with a necrotic testis (Figure 3A)
Most of the cases happen before birth and only about 20% occur following delivery [2, 3] About 150 perinatal TT have been reported since 2010, with a significant percentage of bilateral cases [4]
Summary
Neonatal testicular torsion (NTT) was first described by Taylor et al in 1897 [1]. It can be either unilateral or, less frequently, bilateral. Right scrotal exploration was done through midline raphe incision and revealed right extra-vaginal testicular torsion with a necrotic testis (Figure 3A). Contralateral exploration showed extra-vaginal testicular torsion with normal vascularity (Figure 3B). Follow-up at 3 months showed that the left testis was normal in size with good blood flow by Doppler signal.
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