Torsión testicular

Question 1

Dx más común en escroto agudo

Answer 1

Torsión de appendix testis
Seguido de torsión de cordón espermático

Question 2

Después de la infancia y antes de pubertad

Answer 2

Torción apéndice

Question 3

Periodo perinatal y puberal

Answer 3

Cordón espermático

Question 4

Clasificación

Answer 4

Question 5

Acute Intravaginal Spermatic Cord Torsion

Answer 5

Excess mobility of the testis within a “bell-clapper deformity,” wherein the tunica vaginalis abnormally fixes proximally on the cord.
El evento desencadenante de la torsión es desconocido pero puede tener que ver temperaturas frías o cambios en temperatura, que crezcan rápido en pubertado activación de reflexo cremastérico

Question 6

Aumento de riesgo de torsión

Answer 6

Criptorquidia

Question 7

Presentación clínica AISCT

Answer 7

Despúes de los 10 años pico 12-16a
Dolor agudo escrotal que puede ocurrir en actividad o rest
Náusea
Vómito
Ausencia reflejo cremastérico

Question 8

The presence of a cremasteric reflex correlates with intact testicular blood flow but does not

Answer 8

unequivocally indicate normal testicular perfusion, especially if the clinical presentation is otherwise suggestive of torsion.

Question 9

Diagnóstico

Answer 9

USG: No flujo en doppler o reducido
Parénquima heterogéneo (que puede indicar necrosis)
Swirl sign showing twist in cord

Question 10

Tratamiento

Answer 10

Surgical emergency – viability related to duration
of torsion; optimal salvage within 6 hours. Preoperative manual detorsion (“opening the book”) – may relieve symptoms exploration still required. Hemiscrotal or mid-line incision; untwist testis, fasciotomy in tunica albuginea to enhance perfusion an option; fix contralateral testis (three nonabsorbable sutures). If torsed testis viable, pex; if not, orchiectomy. If tunica albuginea incised, use graft of tunica vaginalis to cover.

Question 11

Intravaginal intermitente

Answer 11

Periodic episodes, self-limited (0.5–2 hours) acute scrotal pain; may precede acute torsion in 30%–50% of patients.

Question 12

Diagnóstico intermitente

Answer 12

Often no physical exam or imaging findings by
time of evaluation; may have residual swelling.
US edema residual

Question 13

Una vez dx la torsión intermitente se recomienda

Answer 13

Elective bilateral orchidopexy is indicated to avert torsion and possible organ loss.

Question 14

Extravaginal

Answer 14

También llamado perinatal (sin importart si ocurre prenatal, durante parto o postparto
Torsion of the entire cord occurs before fixation of the tunica vaginalis and dartos within the scrotum (extravaginal). This event most commonly occurs well before delivery, yielding a “vanishing” testis or a hemosiderin-containing nubbin in the scrotum or less commonly in the inguinal canal.

Question 15

FR extravaginal

Answer 15

Increased in high birth weight or difficult delivery; may be bilateral – concurrent or metachronous torsion.

Question 16

Diagnóstico extravaginal

Answer 16

Testis hard and fixed, scrotum erythematous or dark, may have hydrocele.
US

Question 17

Tratamiento extravaginal

Answer 17

Controversial. If acute change, immediate explora-
tion to attempt salvage, and prevent contralateral torsion. If born with findings, explore immediately to prevent contralateral torsion versus explore electively since unsalvageable and metachronous torsion rare; concern for increased anesthetic risk in newborn.

Question 18

Torsión de appendix testis

Answer 18

US rarely demonstrates an abnormal appendage but commonly shows hyperperfusion of the epididymis
Torsion of an appendage is a self-limited process

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