Consult a urologist early and obtain an emergent color Doppler ultrasound in cases of suspected torsion, as delay in diagnosis increases the likelihood of a poor outcome.

Torsion of the testicle occurs when the testicle twists on its vascular pedicle, compromising blood flow to and from the testes. Torsion may occur prenatally, during the newborn period, or anytime throughout childhood. The peak incidence is during adolescence, but a smaller peak occurs late in gestation and in the first months of life. Swelling from vascular engorgement occurs when venous drainage is impaired by torsion of the spermatic veins. Arterial compromise occurs when the testicle twists more severely or after longer-standing venous occlusion. The likelihood of testicular viability is directly related to the length of time between the event and surgical detorsion. When corrected within 6 hours of the event, testicular viability approaches 100%; beyond 24 hours, the viability nears 0%. Therefore, a high index of suspicion and immediate surgical consultation are mandatory.

Scrotal pain and swelling are the most common symptoms of testicular torsion. The pain is usually sudden in onset, unilateral, and severe. Irritability may be the presenting symptom in infants. Older children may complain of groin, thigh, or abdominal pain. Vomiting and nausea are sometimes seen. Scrotal swelling may be noted by the parents or the patient.