Overview Snapshot A neonatal boy is brought to his pediatrician for concern of a blue mass in the scrotum. His parents noticed this an hour ago. On physical exam, the scrotum is blue and firm with some erythema. Transillumination test is negative. Doppler ultrasound shows absent blood flow. The neonate is immediately sent to hospital for surgery. Introduction Clinical definition twisting of spermatic cord that results in compromised blood flow and ischemia this is considered a surgical emergency Epidemiology Demographics neonatal adolescent years Risk factors prior history of testicular torsion recent trauma to the testes Etiology Pathogenesis processus vaginalis (path as testes leaves abdomen with peritoneal lining) twists, causing decreased or absent blood flow to the testis and epididymis Presentation Symptoms primary symptoms in adolescents login to view 3 more bullets in neonates login to view 1 more bullet Physical exam inspection high riding testis with a horizontal lie erythema and swelling tenderness to palpation absent cremasteric reflex Imaging Doppler ultrasound indications if testicular torsion is suspected but not confirmed with physical exam and history findings decreased or absent blood flow Studies Urinalysis to rule out epididymitis Diagnostic criteria diagnosed by history and physical exam diagnosis confirmed only during surgery Differential Epididymitis positive cremasteric reflex Torsion of the appendix testis normal cremasteric reflex normal testicular lie positive blue dot sign Treatment Operative orchiopexy (bilateral) indications login to view 2 more bullets bilateral orchiopexy should be performed as contralateral testis is also at risk for future torsion outcomes login to view 3 more bullets orchiectomy indications login to view 1 more bullet Non-operative manual detorsion indications login to view 1 more bullet Complications Testicular ischemia Infertility or subfertility Prognosis Prognostic variable favorable rapid time to surgery