TWISTED FATE: THE TWISTS AND TURNS OF TORSION-DETORSION SYNDROME

In children, acute scrotal pain is a common source of urological consultation in the Emergency Department (ED). The annual incidence of acute testicular torsion is low, however, despite the small number of cases, a diagnosis of testicular torsion (TT) is very crucial as it can result in non-salvageable testes. Color Doppler Ultrasound (CDUS) is the most effective and convenient test in diagnosing TT with a high diagnostic sensitivity and specificity. Torsion-detorsion syndrome (TDS) is when the testicle undergoes repeated episodes of twisting and untwisting of the spermatic cord. In contrast to TT, the findings on CDUS in TDS may vary. The intermittent nature of the torsion episodes and the variable results on CDUS make surgical exploration a crucial step in confirming the diagnosis of TDS. In this case report, we present a patient with recurrent episodes of acute scrotal pain but negative results on CDUS. This case highlights the potential for misdiagnosis of TDS. Clinicians should be highly vigilant in cases of recurring episodes of acute scrotal pain, despite negative imaging tests. If left untreated, TDS can progress into TT whereby the testicular salvage is attainable only if intervention is undertaken within 6 hours of the onset of pain.