Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency

Abstract

Objective: To evaluate the features of testicular torsion (TT) resulting from minor groin trauma and to raise the awareness of trauma-induced testicular torsion (TITT). Methods: This is a retrospective chart review of patients presenting with TT resulting from minor genital trauma that was performed from January 2010 to December 2018 at a single tertiary care institution. The demographic, clinical, and perioperative characteristics, as well as data on follow-up and complications, were analyzed. Results: Of the 155 patients treated for TT, 15 were included in this study. The average age of the patients was 10.3 years (range: 3.2–13.3 years). All patients experienced a direct scrotal trauma and subsequently presented with an ipsilateral scrotal or testicular pain secondary to the twisted testicle. Six patients were misdiagnosed as having scrotal inflammation or hematoma, and all were initially treated at local hospitals. The mean duration of symptoms before hospitalization was 138 h (range: 5–504 h). The mean degree of torsion was 390° (range: 180–720°). The testicular salvation rate, at 33%, was poor. No serious postoperative complications or recurrences of TT was observed. Conclusions: TITT is a rare entity and still has delayed diagnosis. This may subsequently lead to a low testicular salvation rate. Emergency surgeons, especially in local hospitals, should be aware of the possibility of TT following testicular trauma in pediatric patients. Improving the parents’ awareness regarding TT is also important.