Case Of Torsion Research Articles

A Case of Torsion of the Undescended Testis

This article presents the case of a 14-year-old male who experienced acute torsion of an undescended testis located in the right inguinal canal. The patient presented with severe right inguinal pain. Imaging studies, including CT and MRI, revealed the underlying pathology. Intraoperative findings confirmed testicular necrosis, necessitating an orchiectomy. This report aims to highlight the clinical presentation, radiological findings, and surgical management of this condition, supplemented with relevant images.

Testicular Torsion Following MMR Vaccination in an 18-Month-old Infant: A Case Report

Introduction: The measles, mumps, and rubella (MMR) vaccine is associated with known complications, such as salivary gland involvement and aseptic meningitis. Isolated reports of epididymal orchitis following MMR vaccination have also been reported, but no reported case of testicular torsion in infancy has been explicitly attributed to the MMR vaccine. Objective: Here, we report an 18-month-old male infant presented with a history of gradually worsening painful left scrotal swelling following a booster dose of MMR that finally led to orchiectomy with the diagnosis of testicular torsion. Case Presentation: An 18-month-old male infant presented with a one-day history of gradually worsening painful left scrotal swelling following a booster dose of MMR. No evidence of blood flow was detected in the left testicle in color Doppler sonography, which was compatible with testicular torsion. In surgical exploration, the left testicle seemed firm and dark in color. The spermatic cord vessels were thrombotic in appearance, and the testicular appendix seemed completely necrotic. The nonviable left testicle was removed. Conclusions: Although testicular torsion after MMR vaccination is rare, in the case of any pain, swelling, and redness of the scrotum, the patient should seek an urgent medical consultation. Physicians should be aware that testicular swelling after the MMR vaccine might not be just epididymal-orchitis but really a medical emergency.

Deciphering ovarian torsion: insights from CT imaging analysis.

In the milieu of emergency medicine, pelvic and lower abdominal pain present recurrently, with ovarian torsion posing a formidable diagnostic quandary amid multifarious etiologies. Given the burgeoning reliance on CT in acute care settings, it invariably assumes primacy as the principal imaging modality. This study endeavors to elucidate the CT imaging manifestations encountered by surgically confirmed ovarian torsion patients and utilizing CT to differentiate necrosis. A retrospective analysis (January, 2015- April, 2019) utilizing hospital archives was conducted on patients diagnosed with ovarian torsion, post-surgery. Inclusion criteria encompassed patients who underwent CT examinations within one week of diagnosis. A large array of CT findings encompassing midline orientation, uterine deviation, intraovarian hematoma/mass, and multiple others were systematically documented. 90 patients were diagnosed with ovarian torsion- 53 (59%) had CT within one week of diagnosis, 41(77%) underwent a CT with IV contrast and 12 (23%) without IV contrast. Mean age was 43 years (range 19-77 years), with near equal distribution of involvement of each ovary. Mean maximum ovarian diameter was 11.7 ± 6.3cm (4.2-34.8cm). Most common imaging features include the presence of thickened pedicle (43/53, 81%), midline ovary (41/53, 77%), presence of thickened fallopian tube (31/49, 63%), and ipsilateral uterine deviation (33/53, 62%). Based on contemporaneous imaging report, torsion was diagnosed in 25/ 53 studies giving a sensitivity of 47%. Enlarged ovarian dimensions (> 3.0cm), thickened vascular pedicle or fallopian tube, midline ovarian disposition with ipsilateral uterine deviation, and the presence of a whirlpool sign emerged as predominant CT imaging features in surgically confirmed ovarian torsion cases, serving as pivotal diagnostic aides for radiologists. Concomitant pelvic free fluid and intraovarian hematoma signify necrotic changes, indicative of ischemic severity and disease progression.

A VERY RARE CASE: THE DEVELOPMENT OF TUBA-OVARİAN TORSİON İN ENDOMETRİOMA

Endometriosis is increasingly diagnosed in women of reproductive age and is estimated to affect up to 10% of women. Endometriomas are a common antithesis in patients of reproductive age and require special planning and experience for optimal treatment. Endometroma in rare cases occurs with an acute abdominal picture. However, adnexal torsion is very rare in these patients. Because endometriomas are often tightly adherent to neighboring structures, and therefore they seem less likely to cause adnexal torsion, although there is insufficient data on the torsion rate in these cysts. With this case report, we thought to contribute to the literature with the case of torsion in endometrioma.

PROGNOSTIC FACTORS FOR ORCHIDECTOMY IN TESTICULAR TORSION PATIENTS AT TERTIARY HOSPITAL

Objective: This study was conducted to analyze the prognostic factors for orchidectomy in testicular torsion patients. Material & Methods: From January 2001 to December 2021, 100 cases of testicular torsion cases were retrospectively collected. Data were described and analyzed based on clinical factors (age, duration of symptoms, scrotal swelling, high-riding testis, Prehn test, cremasteric reflex, leukocytosis, degree of twisting) and non-clinical factors (distance from hospital, duration of travel to hospital, education level and employment status) for each surgical procedure. Then logistic regression analysis was performed. Results: There were 88 testicular torsion patients (88%) underwent orchidectomy and 12 patients (12%) underwent orchidopexy. There was no significant relationship between age, duration of symptoms, scrotal swelling, Prehn test, cremasteric reflex, leukocytosis, distance from hospital, duration of travel to hospital, education level and employment status with orchidectomy (p>0.05). Significant prognostic factors for orchidectomy in testicular torsion patients were high-riding testis (OR = 0.06; 95% CI = 0.01-0.37; p = 0.002) and degree of twisting (OR = 0.04; 95% CI = 0.006-0.24; p = 0.000). Conclusion: High-riding testis and degree of twisting are prognostic factors for orchidectomy in testicular torsion patients. Keywords: Orchidectomy, prognostic factors, testicular torsion.

Torsione ovarica: la questione tempo

An 8-month-old girl presented to the ER with abdominal pain and drowsiness. Ultrasound suggested ovarian torsion, which was later confirmed via laparoscopy, revealing left ovarian and tubal torsion with uterine torsion. Prompt intervention prevented hysterectomy, underscoring the importance of early diagnosis and rapid surgical action in suspected ovarian torsion cases.

UNILATERAL OVARIAN TORSION IN FIVE GECKOS: CLINICAL AND ULTRASOUND FINDINGS.

Few cases of antemortem ovarian torsion and diagnosis have been described in reptiles. This case series reports clinical and ultrasound findings in five adult (aged 1-6 yr) female geckos (three leopard geckos [Eublepharis macularius], one crested gecko [Correlophus ciliatus], and one gargoyle gecko [Rhacodactylus auriculatus]) diagnosed with unilateral ovarian torsion between 2019 and 2023. All animals presented with acute weakness associated with coelomic distension, and one suffered from chronic diarrhea and cachexia. Coelomic ultrasound examination (12-MHz linear probe) revealed signs of bilateral follicular stasis and oophoritis in all cases (heterogenic follicles ≤1.3 cm diameter) associated with a large anechoic periovarian rim and a hyperechoic chord, consistent with twisted ovarian vessels. Blood supply to ovarian structures was not detected using a Doppler flow, and a unilateral ovarian torsion was diagnosed in all geckos. A bilateral ovariectomy was performed under general anesthesia in all five animals. The mass of the excised ovaries varied between 7 to 15 g (12.7-22.2% of body weight). One gecko died 1 d postsurgery; the four remaining animals were healthy 6 mon postsurgery. Gekkonids are unique among reptiles in that they undergo a monoautochronic ovulation (only one follicle is recruited by each ovary during each ovarian cycle); the presence of multiple vitellogenic follicles on each ovary facilitates the diagnosis of follicular stasis. This condition was present in all five geckos and was suspected to have led to ovarian torsion. This case series emphasizes the value of ultrasound examination for antemortem diagnosis of reproductive disorders in reptiles.

Spherocytosis as an indicator of fragmentation injury in dogs with splenic torsion.

To describe the presentation, diagnosis, and treatment of 4 cases of splenic torsion with associated spherocytosis. 4 client-owned dogs with spherocytosis and splenic torsion. Each dog presented with nonspecific clinical signs, and 3 out of 4 dogs were anemic on presentation. The diagnosis of splenic torsion was made with abdominal ultrasound or CT and confirmed during exploratory laparotomy. Spherocytosis was described as occasional (patient 1), rare (patient 2), and low number (patients 3 and 4). Two dogs survived to hospital discharge, and 2 dogs died following cardiorespiratory arrest. Spherocytosis has not previously been reported in cases of splenic torsion, and identification of spherocytes on blood film evaluation warrants further investigation. The cause of spherocytosis in splenic torsion remains unknown but may be associated with microangiopathic fragmentation injury.

The Application Value of Ultrasound in the Diagnosis of Ovarian Torsion

In a study of 80 patients suspected of ovarian torsion and necrosis admitted to our hospital between January and December 2023, we analyzed the results of abdominal and vaginal ultrasounds with surgical diagnoses as the reference. Of the 80 cases, 74 were confirmed as ovarian torsion, accounting for 92.50%, while the remaining diagnoses included ruptured corpus luteum cysts, periapendiceal abscesses, and ruptured ectopic pregnancies, each with 2 cases. Abdominal ultrasound identified 63 cases of ovarian torsion and 17 cases of non-ovarian torsion, whereas vaginal ultrasound identified 73 cases of ovarian torsion and 7 cases of non-ovarian torsion. The sensitivity, specificity, and accuracy of abdominal ultrasound were 82.43%, 66.67%, and 78.75%, respectively, while those of vaginal ultrasound were 94.59%, 50.00%, and 91.25%. Although there was no statistical difference in specificity between the two methods (P > 0.05), vaginal ultrasound demonstrated significantly higher sensitivity and accuracy compared to abdominal ultrasound (P < 0.05). Thus, vaginal ultrasound is a more reliable diagnostic tool for ovarian torsion, providing valuable information for clinicians and improving diagnostic accuracy.

Is The Dorsal Dartos Flap Rotation Technique Successful in Children with Isolated Penile Torsion?

Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the results of dorsal dartos flap rotation technique in children with isolated penile torsion. 5470 boys who applied to our clinic between 2012 and 2022 for circumcision were evaluated for congenital isolated penile torsion. They were classified according to the degree and direction of torsion and clinical findings were analyzed. According to the degree of torsion, penile degloving or dorsal dartos flap rotation technique with circumcision was performed. Patients whose torsion corrected after penile degloving were excluded from the study. The results of dorsal dartos flap rotation technique were evaluated. Results: Congenital isolated penile torsion ≥60° was identified in 1.04 % (n=57) of the children. Eight patients whose torsion corrected after penile degloving were excluded from the study. 49 patients who underwent dorsal dartos flap rotation had a mean age of 4.94 years (1-9) and a mean operation time of 29.9 min (20-40). The mean degree of torsion was 77.6° (60-110). The mean operation times in the < 90° and ≥ 90° dorsal dartos flap groups were statistically significant (p<0.05). Residual torsion was statistically significant in the < 90° and ≥ 90° dorsal dartos flap groups (p<0.05). At the postoperative 1st and 6th month follow-ups, torsion less than 10 degrees was observed in 3 patients who underwent dorsal dartos flap rotation technique. No residual torsion was observed in other patients. Isolated penile torsion cases should not be overlooked during circumcision. It seems possible to obtain successful results with dorsal dartos flap rotation in moderate and severe torsions.

Adipose tissue torsion with localized lymphangiectasia in a Rio Cauca caecilian Typhlonectes natans.

A female Rio Cauca caecilian Typhlonectes natans (estimated as between 10 and 18 years of age) housed at the Smithsonian National Zoological Park in Washington, D.C., developed progressive severe coelomic effusion over a 4-week period. The coelomic effusion was diagnosed via radiographs and ultrasound, and a sample of the fluid was obtained for analysis, which revealed a low-protein transudate suggestive of inflammation. As the coelomic effusion progressed, the caecilian became tachypneic, hyporexic, and lethargic. The caecilian was started on antibiotics and a diet trial, but signs continued despite therapy. An exploratory celiotomy was performed, which revealed adipose tissue torsion with local lymphangiectasia and a presumptive biliary cyst. Surgical correction was unable to be achieved due to concern for fatal hemorrhage, as the vasculature associated with the torsion was severely distended. Due to the severity of the torsion and associated risks, the caecilian was euthanized intraoperatively and subsequently necropsied for histologic evaluation. After reviewing the caecilian's presentation and the progression of disease, it is suspected that the severe coelomic effusion was secondary to lymphangiectasia, which occurred subsequent to the adipose tissue torsion. This is the first reported case of adipose tissue torsion and associated clinical disease in an aquatic caecilian and should be a differential for progressive coelomic effusion in this species.

A case of ovarian torsion in pregnancy

A case of ovarian torsion in pregnancy

Understanding deformation and fracture mechanism of Ti-55531 alloy under complex loading conditions: a case of pre-tensioned torsion

Understanding deformation and fracture mechanism of Ti-55531 alloy under complex loading conditions: a case of pre-tensioned torsion

Westerfit: A new program for spin–torsion–rotation spectra

A new program, westerfit, has been developed to treat Cs molecules with internal rotation and spin angular momentum. It implements a single diagonalization Rho Axis Method approach for the torsion–rotation alongside a complete treatment of nuclear quadrupole interaction and spin–rotation coupling. Unlike other programs designed for internal rotation with spin effects, westerfit includes matrix elements off-diagonal in the rotational angular momentum quantum number, N, rather than the perturbative treatment of the spin–rotation and quadrupole interactions. This full combined approach allows fitting of all symmetrically allowed terms in both the spin–rotation and the quadrupole tensors as well as inclusion of higher order terms coupling the large amplitude motion to the spin angular momentum. The program was benchmarked against other published programs to test molecular cases of torsion–rotation, spin–rotation, and spin–torsion-rotation. All three tests produced a lower RMS. westerfit paves a way forward for complete treatment of spin–torsion–rotation problems regardless of barrier height or quadrupole moment.

Imaging Features of Uncommon Entities That Manifest with Torsion.

Torsion is the twisting of an object along the axis, and various structures (organs and tumors) in the body can twist. Torsion causes initial lymphatic and venous outflow obstruction, leading to congestive edema, enlargement, venous hemorrhagic infarction, and surrounding edema. It can also cause subsequent arterial obstruction depending on the degree of torsion, leading to ischemia, infarction, necrosis, gangrene, and surrounding inflammation. Therefore, in several cases of torsion, immediate surgical intervention is required to improve blood flow and prevent serious complications. Clinical manifestations of torsion are often nonspecific and can affect individuals of varying ages and sex. Imaging plays an important role in the early diagnosis and management of torsion. Multiple imaging modalities, including US, radiography, CT, and MRI, are used to evaluate torsion, and each modality has its specific characteristics. The imaging findings reflect the pathophysiologic mechanism: a twisted pedicle (whirlpool sign), enlargement of the torsed structures, reduced blood flow, internal heterogeneity, and surrounding reactive changes. The whirlpool sign is a definitive characteristic of torsion. In some cases, despite poor internal enhancement, capsular enhancement is observed on contrast-enhanced CT and MR images and is considered to be associated with preserved capsular arterial flow or capsular neovascularization due to inflammation. Radiologists should be familiar with the pathophysiologic mechanisms, clinical characteristics, and imaging characteristics of torsion in various structures in the body. Since other articles about common organ torsions already exist, the authors of this article focus on the uncommon entities that manifest with torsion. ©RSNA, 2024.

Ovarian cyst mimicking acute appendicitis in children: a case report

Pediatric acute appendicitis is common; however, it is different from torsion ovarian cysts. The estimated incidence of ovarian torsion in children is 5 per 100,000 girls. Herein, we report two cases of ovarian torsion mimicking pediatric acute appendicitis mimicking ovarian cyst. In the first case, a girl who was being assessed for acute appendicitis was identified to have torsion of the ovarian cyst during the surgery. In the second case, a girl experienced a ruptured ovarian cyst but then got severe appendicitis following the surgical procedure. The simultaneous occurrence of appendicitis and ovarian cysts is rare. These two patients' acute gastrointestinal complaints and symptoms exhibit similarities and may coincide. Both patients underwent salpingo-oopherectomy and appendectomy. Both patients were healthy on hospital discharge in a healthy condition. Female patients with severe abdominal pain and amenorrhea should be evaluated for ovarian torsion. Diagnosing the condition may be challenging due to non-specific clinical signs.

Unusual left colon displacement and clockwise torsion in a 10‐month‐old Arab filly: A case report

In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10‐month‐old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention.A 10‐month‐old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the filly exhibited sweating, a body temperature of 38.5°C, tachycardia (65 beats per minute) and tachypnea (25 breaths per minute). Due to the severity of the colic and the lack of response to the conservative treatments, surgical intervention was deemed necessary. An exploratory midline celiotomy was performed to evaluate the abdominal organs. During the examination, no obvious primary lesions were identified in the evaluated organs. However, a restriction in exteriorizing the left colon's length was observed. Further examination revealed an unusual clockwise torsion of the left colon that displaced in left to the right side around the mesenteric root; thereby, pelvic flexure was located in the normal anatomical position with a short length.To the best of our knowledge, this is the first reported case of clockwise torsion and an atypical displacement of the left colon in horses. The surgical correction of the displacement was successfully performed. The filly showed improvement post‐surgery and did not exhibit any complications during the recovery period.

Ovarian torsion in a 4-year-old girl: case report

Introduction: Ovarian torsion, a rare surgical emergency in children, is one of the uncommon causes of acute abdominal pain. In this study, a case of ovarian torsion in a 4-year-old female patient was reported. Case Presentation: A four-year-old female came to Bent al-Huda Hospital in Bojnurd, Iran with a complaint of abdominal pain that had started the day before the visit and was colicky. Abdominal examination showed tenderness in the right lower quadrant. The complete blood count (CBC) test was normal. In the Doppler ultrasound of the abdomen and pelvis, partial right ovarian torsion was observed. The patient underwent torsion under laparotomy and the ovary was preserved. Due to the length of the right utero vaginal ligament, the utero vaginal ligament was shortened with 8 stitches and fixed to the pelvic wall. The ovary was placed in its normal anatomical position and the abdominal wall was repaired. In the examination of the complete serial blood cell count, the test results were normal, and the patient was discharged 72 h after surgery in good general condition. Conclusion: Considering the non-specificity of ovarian torsion symptoms, the possibility of ovarian torsion should be considered in all female children with abdominal pain. However, ovarian torsion in children is a rare emergency that requires early and timely evaluation, diagnosis, and intervention to prevent subsequent catastrophic consequences.

A case report of recurrent ovarian torsion following oocyte cryopreservation managed with dual technique oophoropexy

Introduction: Ovarian torsion is a known risk of ovarian hyperstimulation done as part of fertility treatments. The purpose of this case report is to describe an unusual case of recurrent ovarian torsion following oocyte cryopreservation that was ultimately managed with ovarian detorsion and dual technique oophoropexy. Case Report: The patient presented is a 25-yearold female with history of recurrent ovarian torsion who underwent fertility preservation with ovarian cryopreservation in the setting of risk for ovarian loss in the case of recurrent torsion episodes. Following ovarian hyperstimulation and oocyte retrieval, the patient experienced three recurrent episodes of torsion which were surgically managed. On the third episode, a dual technique oophoropexy was performed using both utero-ovarian ligament plication and ovarian fixation. Conclusion: This case describes an unusual presentation of an uncommon complication of ovarian stimulation. During her surgical management of recurrent ovarian torsion, ovarian conservation was prioritized and a dual oophoropexy technique was utilized which has thus far prevented further recurrent episodes of torsion.

Ultrasonographic findings of a rare case of splenic rupture and torsion in a dog

AbstractA 7‐year‐old dog presented with acute lethargy, anorexia and vomiting. Ultrasonographic examination revealed a hypoechoic mass lesion in the left abdomen, characterised by a hilum‐like structure and intraparenchymal gas. A mild amount of hyperechoic peritoneal effusion was present. An apparently normal spleen was visualised, which was not associated with the described mass lesion. Surgery revealed a presumed previously ruptured and separated spleen. The caudal portion of the spleen was acutely torsed and there was a mild amount of peritoneal fluid present. Histopathology confirmed splenic torsion of the previously ruptured and separated caudal splenic segment. Bacterial culture of the peritoneal effusion after enrichment indicated Staphylococcus aureus. The patient recovered successfully and maintained excellent clinical conditions at 14‐month follow‐up. Splenic torsion of a ruptured splenic segment should be considered as a differential diagnosis for an emphysematous mass containing a hilum‐like structure in the abdomen in dogs.