Clinical analysis of testicular torsion with the primary symptom of abdominal pain in adolescents and boys

Abstract

Objective To evaluate the characteristics of the testicular torsion patients with the first symptom of acute abdominal pain. Methods From October 1998 to May 2014, 8 adolescent or boys with testicular torsion presenting acute abdominal pain instead of scrotal pain as their primary symptom were retrospectively reviewed. The average age was 12 (3-16) years. An acute abdominal pain presented firstly in all cases, which accompanied by nausea and vomiting in 4 cases, groin pain in 2 cases, fever in 1 case. In genital examination, the scrotum skin was red and swollen, while the testis was in transverse position and tenderness. The testicular and homolateral abdominal pain got worse when we pulled the involved testis. Doppler ultrasound examination revealed that the blood supply of the involved testis decreased or disappeared. Results In the 8 cases, 5 cases were not examined their testicles or scrotum during the first evaluation, which were found the testicular necrosis during the following exploratory surgery, and orchidectomy was performed. In the other 3 cases, external genital were examined during the first evaluation, and the scrotal and testicular abnormalities were detected. Doppler ultrasonography showed abnormality in testicular blood supply. Testicular torsion was proved during the emergent operation, and the 3 testes were salvaged. The mean duration time from symptom onset to operation was 4 h in the salvaged group, while the average time was 28 h in the orchiectomy group. The mean follow-up time was 18 (10-36) months. In the 3 cases whose testis was saved, 1 affected testis was atrophied, and the blood supply of the other two was good. No severe complications occurred in the other 5 cases. Conclusions Testicular torsion should be considered in adolescents and boys with acute lower abdominal pain. The routine external genital examination should be performed when a boy or adolescent complains of abdominal pain. Key words: Testicular torsion; Adolescent and children; Acute abdominal pain; Acute scrotal pain