Late Phase Testicular Torsion in Pre-Geriatic Age: A Case Report

Background: Testicular torsion is a urological emergency caused by a twist of spermatic cord, which result in testicular tissue ischemia and requiring immediate surgery. The incidence occurred generally in children and adolescents, rarely found in adults. Severe Scrotal pain is the most common manifestation of testicular torsion. The definitive treatment for testicular torsion is surgery, either one of orchidopexy or orchidectomy. The prognosis of testicular torsion depends on the onset of symptoms and the decision time for surgery. Case Report: A 52-year-old man presented to emergency department with a history of gradual severe right-sided scrotal pain (visual analogue scale 8) radiated to the right groin in the last 3 day before admission. Previously, the patient's genitals were hit by the table. On physical examination, the testicles were found to be asymmetrical, swollen, redness, tenderness, and the testicle felt hard and immobilized, either the cremaster reflex or the Phren sign test were negative. The TWIST score was 6 (high risk for testicular torsion). Orchidopexy and orchidectomy were performed immediately without Scrotal Doppler Ultrasonography due to operational problems. Histopathology examination of the orchidectomy specimen impression showed an inflammation sign with exudative fluid presentation. Conclusion: Gradual Severe scrotal pain manifestations should be suspected as testicular torsion as soon as possible before it evolves into later phase. One of the causes of late phase testicular torsion is late admission to Hospital. Surgical emergency action should be taken considering theemergency state without waiting for ideal sonography.