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<ul id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> <li id="toc-Complications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Complications"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Complications</span> </div> </a> <ul id="toc-Complications-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Risk_factors" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Risk_factors"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Risk factors</span> </div> </a> <ul id="toc-Risk_factors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathophysiology</span> </div> </a> <button aria-controls="toc-Pathophysiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Pathophysiology subsection</span> </button> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> <li id="toc-Intermittent_testicular_torsion" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Intermittent_testicular_torsion"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Intermittent testicular torsion</span> </div> </a> <ul id="toc-Intermittent_testicular_torsion-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Extravaginal_testicular_torsion" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Extravaginal_testicular_torsion"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Extravaginal testicular torsion</span> </div> </a> <ul id="toc-Extravaginal_testicular_torsion-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Intravaginal_testicular_torsion" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Intravaginal_testicular_torsion"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Intravaginal testicular torsion</span> </div> </a> <ul id="toc-Intravaginal_testicular_torsion-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Torsion_of_the_testicular_appendix" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Torsion_of_the_testicular_appendix"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Torsion of the testicular appendix</span> </div> </a> <ul id="toc-Torsion_of_the_testicular_appendix-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Torsion_of_the_undescended_testicle" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Torsion_of_the_undescended_testicle"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.5</span> <span>Torsion of the undescended testicle</span> </div> </a> <ul id="toc-Torsion_of_the_undescended_testicle-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Clinical_exam" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Clinical_exam"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Clinical exam</span> </div> </a> <ul id="toc-Clinical_exam-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Imaging" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Imaging"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Imaging</span> </div> </a> <ul id="toc-Imaging-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Treatment</span> </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> 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Available in 27 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-27" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">27 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A7%D9%86%D9%81%D8%AA%D8%A7%D9%84_%D8%A7%D9%84%D8%AE%D8%B5%D9%8A%D8%A9" title="انفتال الخصية – Arabic" lang="ar" hreflang="ar" data-title="انفتال الخصية" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Torsi%C3%B3_testicular" title="Torsió testicular – Catalan" lang="ca" hreflang="ca" data-title="Torsió testicular" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Torze_varlete" title="Torze varlete – Czech" lang="cs" hreflang="cs" data-title="Torze varlete" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Hodentorsion" title="Hodentorsion – German" lang="de" hreflang="de" data-title="Hodentorsion" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A3%CF%85%CF%83%CF%84%CF%81%CE%BF%CF%86%CE%AE_%CF%8C%CF%81%CF%87%CE%B5%CF%89%CF%82" title="Συστροφή όρχεως – Greek" lang="el" hreflang="el" data-title="Συστροφή όρχεως" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Torsi%C3%B3n_testicular" title="Torsión testicular – Spanish" lang="es" hreflang="es" data-title="Torsión testicular" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%BE%DB%8C%DA%86%D8%B4_%D8%A8%DB%8C%D8%B6%D9%87" title="پیچش بیضه – Persian" lang="fa" hreflang="fa" data-title="پیچش بیضه" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Torsion_testiculaire" title="Torsion testiculaire – French" lang="fr" hreflang="fr" data-title="Torsion testiculaire" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EA%B3%A0%ED%99%98%EA%BC%AC%EC%9E%84" title="고환꼬임 – Korean" lang="ko" hreflang="ko" data-title="고환꼬임" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%B1%D5%B4%D5%B8%D6%80%D5%B1%D5%B8%D6%82_%D5%B8%D5%AC%D5%B8%D6%80%D5%B8%D6%82%D5%B4" title="Ամորձու ոլորում – Armenian" lang="hy" hreflang="hy" data-title="Ամորձու ոլորում" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Torsione_del_testicolo" title="Torsione del testicolo – Italian" lang="it" hreflang="it" data-title="Torsione del testicolo" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%AA%D7%A1%D7%91%D7%99%D7%91_%D7%90%D7%A9%D7%9A" title="תסביב אשך – Hebrew" lang="he" hreflang="he" data-title="תסביב אשך" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Torsio_testis" title="Torsio testis – Dutch" lang="nl" hreflang="nl" data-title="Torsio testis" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-new mw-list-item"><a href="https://new.wikipedia.org/wiki/%E0%A4%9F%E0%A5%87%E0%A4%B8%E0%A5%8D%E0%A4%9F%E0%A4%BF%E0%A4%95%E0%A5%81%E0%A4%B2%E0%A4%B0_%E0%A4%9F%E0%A5%8B%E0%A4%B0%E0%A5%8D%E0%A4%B8%E0%A4%A8" title="टेस्टिकुलर टोर्सन – Newari" lang="new" hreflang="new" data-title="टेस्टिकुलर टोर्सन" data-language-autonym="नेपाल भाषा" data-language-local-name="Newari" class="interlanguage-link-target"><span>नेपाल भाषा</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E7%B2%BE%E5%B7%A3%E6%8D%BB%E8%BB%A2%E7%97%87" title="精巣捻転症 – Japanese" lang="ja" hreflang="ja" data-title="精巣捻転症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%9F%E0%AD%87%E0%AC%B7%E0%AD%8D%E0%AC%9F%E0%AC%BF%E0%AC%95%E0%AD%81%E0%AC%B2%E0%AC%BE%E0%AC%B0_%E0%AC%9F%E0%AC%B0%E0%AD%8D%E0%AC%B8%E0%AC%A8" title="ଟେଷ୍ଟିକୁଲାର ଟର୍ସନ – Odia" lang="or" hreflang="or" data-title="ଟେଷ୍ଟିକୁଲାର ଟର୍ସନ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Tor%C3%A7%C3%A3o_testicular" title="Torção testicular – Portuguese" lang="pt" hreflang="pt" data-title="Torção testicular" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9F%D0%B5%D1%80%D0%B5%D0%BA%D1%80%D1%83%D1%82_%D1%8F%D0%B8%D1%87%D0%BA%D0%B0" title="Перекрут яичка – Russian" lang="ru" hreflang="ru" data-title="Перекрут яичка" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A2%D0%BE%D1%80%D0%B7%D0%B8%D1%98%D0%B0_%D1%81%D0%B5%D0%BC%D0%B5%D0%BD%D0%B5_%D0%B2%D1%80%D0%BF%D1%86%D0%B5" title="Торзија семене врпце – Serbian" lang="sr" hreflang="sr" data-title="Торзија семене врпце" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Torzija_semene_vrpce" title="Torzija semene vrpce – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Torzija semene vrpce" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Kiveksen_kiertyminen" title="Kiveksen kiertyminen – Finnish" lang="fi" hreflang="fi" data-title="Kiveksen kiertyminen" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Testistorsion" title="Testistorsion – Swedish" lang="sv" hreflang="sv" data-title="Testistorsion" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Testis_torsiyonu" title="Testis torsiyonu – Turkish" lang="tr" hreflang="tr" data-title="Testis torsiyonu" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9F%D0%B5%D1%80%D0%B5%D0%BA%D1%80%D1%83%D1%82_%D1%8F%D1%94%D1%87%D0%BA%D0%B0" title="Перекрут яєчка – Ukrainian" lang="uk" hreflang="uk" data-title="Перекрут яєчка" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Xo%E1%BA%AFn_tinh_ho%C3%A0n" title="Xoắn tinh hoàn – Vietnamese" lang="vi" hreflang="vi" data-title="Xoắn tinh hoàn" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-zh-yue mw-list-item"><a href="https://zh-yue.wikipedia.org/wiki/%E7%9D%BE%E4%B8%B8%E6%89%AD%E6%9B%B2" title="睾丸扭曲 – Cantonese" lang="yue" hreflang="yue" data-title="睾丸扭曲" data-language-autonym="粵語" data-language-local-name="Cantonese" class="interlanguage-link-target"><span>粵語</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E7%9D%BE%E4%B8%B8%E6%89%AD%E8%BD%89" title="睾丸扭轉 – Chinese" lang="zh" hreflang="zh" data-title="睾丸扭轉" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q1434575#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></span></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu vector-menu-tabs mw-portlet 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.infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Testicular torsion</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Illu_testis_surface.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/c/c3/Illu_testis_surface.jpg" decoding="async" width="194" height="250" class="mw-file-element" data-file-width="194" data-file-height="250" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens)</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Urology" title="Urology">Urology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Severe <a href="/wiki/Testicular_pain" title="Testicular pain">testicular pain</a>, elevated testicle<sup id="cite_ref-Lud2016_1-0" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Infertility" title="Infertility">Infertility</a><sup id="cite_ref-AFP2013_2-0" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">Sudden<sup id="cite_ref-Lud2016_1-1" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Types</th><td class="infobox-data">Intravaginal torsion, extravaginal torsion<sup id="cite_ref-Lud2016_1-2" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">"Bell clapper deformity", <a href="/wiki/Testicular_tumor" class="mw-redirect" title="Testicular tumor">testicular tumor</a>, cold temperature<sup id="cite_ref-Lud2016_1-3" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms<sup id="cite_ref-Lud2016_1-4" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Epididymitis" title="Epididymitis">Epididymitis</a>, <a href="/wiki/Inguinal_hernia" title="Inguinal hernia">inguinal hernia</a>, <a href="/wiki/Torsion_of_the_appendix_testicle" class="mw-redirect" title="Torsion of the appendix testicle">torsion of the appendix testicle</a><sup id="cite_ref-AFP2013_2-1" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Physically untwisting the testicle, surgery<sup id="cite_ref-Lud2016_1-5" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">Generally good with rapid treatment<sup id="cite_ref-Lud2016_1-6" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">~1 in 15,000 per year (under 25 years old)<sup id="cite_ref-AFP2013_2-2" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PC2010_3-0" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Testicular torsion</b> occurs when the <a href="/wiki/Spermatic_cord" title="Spermatic cord">spermatic cord</a> (from which the <a href="/wiki/Testicle" title="Testicle">testicle</a> is suspended) twists, cutting off the <a href="/wiki/Blood_supply" class="mw-redirect" title="Blood supply">blood supply</a> to the testicle.<sup id="cite_ref-PC2010_3-1" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The most common symptom in children is sudden, severe <a href="/wiki/Testicular_pain" title="Testicular pain">testicular pain</a>.<sup id="cite_ref-Lud2016_1-7" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The testicle may be higher than usual in the <a href="/wiki/Scrotum" title="Scrotum">scrotum</a> and <a href="/wiki/Vomiting" title="Vomiting">vomiting</a> may occur.<sup id="cite_ref-Lud2016_1-8" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AFP2013_2-3" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> In <a href="/wiki/Newborns" class="mw-redirect" title="Newborns">newborns</a>, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place.<sup id="cite_ref-Lud2016_1-9" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Most of those affected have no obvious prior underlying health problems.<sup id="cite_ref-Lud2016_1-10" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Testicular <a href="/wiki/Tumor" class="mw-redirect" title="Tumor">tumor</a> or prior trauma may increase risk.<sup id="cite_ref-Lud2016_1-11" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PC2010_3-2" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Other risk factors include a <a href="/wiki/Congenital_disorder" class="mw-redirect" title="Congenital disorder">congenital malformation</a> known as a "bell-clapper deformity" wherein the testis is inadequately attached to the scrotum allowing it to move more freely and thus potentially twist.<sup id="cite_ref-Lud2016_1-12" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Cold temperatures may also be a risk factor.<sup id="cite_ref-Lud2016_1-13" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Medical_diagnosis" title="Medical diagnosis">diagnosis</a> should usually be made based on the presenting symptoms, but requires timely diagnosis and treatment to avoid testicular loss.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources"><span title="This citation requires a reference to the specific page or range of pages in which the material appears. (July 2021)">page needed</span></a></i>]</sup><sup id="cite_ref-Lud2016_1-14" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AFP2013_2-4" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> An <a href="/wiki/Ultrasound" title="Ultrasound">ultrasound</a> can be useful when the diagnosis is unclear.<sup id="cite_ref-AFP2013_2-5" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Treatment is by physically untwisting the testicle, if possible, followed by surgery.<sup id="cite_ref-Lud2016_1-15" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Pain can be treated with <a href="/wiki/Opioids" class="mw-redirect" title="Opioids">opioids</a>.<sup id="cite_ref-Lud2016_1-16" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Outcome depends on time to correction.<sup id="cite_ref-Lud2016_1-17" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> If successfully treated within six hours onset, it is often good. However, if delayed for 12 or more hours the testicle is typically not salvageable.<sup id="cite_ref-Lud2016_1-18" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> About 40% of people require <a href="/wiki/Orchiectomy" title="Orchiectomy">removal of the testicle</a>.<sup id="cite_ref-AFP2013_2-6" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>It is most common just after birth and during <a href="/wiki/Puberty" title="Puberty">puberty</a>.<sup id="cite_ref-AFP2013_2-7" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> It occurs in about 1 in 4,000 to 1 in 25,000 males under 25 years of age each year.<sup id="cite_ref-AFP2013_2-8" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PC2010_3-3" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Of children with testicular pain of rapid onset, testicular torsion is the cause of about 10% of cases.<sup id="cite_ref-AFP2013_2-9" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Complications may include an <a href="/wiki/Infertility" title="Infertility">inability to have children</a>.<sup id="cite_ref-AFP2013_2-10" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The condition was first described in 1840 by <a href="/wiki/Louis_Delasiauve" title="Louis Delasiauve">Louis Delasiauve</a>.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Testicular torsion usually presents with severe <a href="/wiki/Testicular_pain" title="Testicular pain">testicular pain</a> or pain in the groin and lower abdomen.<sup id="cite_ref-AFP2013_2-11" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Pain generally begins suddenly and typically involves only one side.<sup id="cite_ref-:1_6-0" class="reference"><a href="#cite_note-:1-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> There is often associated nausea and vomiting.<sup id="cite_ref-AFP2013_2-12" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The testicle may lie higher in the scrotum due to twisting and subsequent shortening of the spermatic cord<sup id="cite_ref-:1_6-1" class="reference"><a href="#cite_note-:1-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> or may be positioned in a horizontal orientation. Mild warmth and redness of the overlying area may be present. Elevation of the testicle may worsen the pain. Urinary symptoms, such as pain or increased frequency of urination are also typically absent.<sup id="cite_ref-uribe_7-0" class="reference"><a href="#cite_note-uribe-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Symptom onset often follows physical activity or trauma to the testes or scrotum. Children with testicular torsion may awaken with testicular or abdominal pain in the middle of the night or in the morning.<sup id="cite_ref-:0_8-0" class="reference"><a href="#cite_note-:0-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> There may be a history of previous, similar episodes of scrotal pain due to prior transient testicular torsion with spontaneous resolution.<sup id="cite_ref-:1_6-2" class="reference"><a href="#cite_note-:1-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Complications">Complications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=2" title="Edit section: Complications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Prose plainlinks metadata ambox ambox-style ambox-Prose" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/40px-Edit-clear.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/60px-Edit-clear.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/80px-Edit-clear.svg.png 2x" data-file-width="48" data-file-height="48" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">This article <b>is in <a href="/wiki/MOS:LIST" class="mw-redirect" title="MOS:LIST">list</a> format but may read better as <a href="/wiki/MOS:PROSE" class="mw-redirect" title="MOS:PROSE">prose</a></b>.<span class="hide-when-compact"> You can help by <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Testicular_torsion&action=edit">converting this article</a>, if appropriate. <a href="/wiki/Help:Editing" title="Help:Editing">Editing help</a> is available.</span> <span class="date-container"><i>(<span class="date">December 2018</span>)</i></span></div></td></tr></tbody></table> <ul><li>Testicular <a href="/wiki/Infarction" title="Infarction">infarction</a>: Testicular damage occurs as a consequence of decreased blood flow, and therefore decreased oxygen and nutrient supply, to the testicle. If the testicle is not viable during surgical exploration, it must be removed to prevent further <a href="/wiki/Necrosis" title="Necrosis">necrosis</a>, or tissue death.</li> <li><a href="/wiki/Infertility" title="Infertility">Infertility</a>:<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The impact of testicular torsion on long-term <a href="/wiki/Fertility" title="Fertility">fertility</a> is not yet fully understood.<sup id="cite_ref-:3_10-0" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> However, testicular torsion may cause abnormal <a href="/wiki/Sperm" title="Sperm">sperm</a> function on <a href="/wiki/Semen_analysis" title="Semen analysis">semen analysis</a>, although these abnormalities are more likely to be found in adolescents and in adults. Torsion does not seem to affect long-term sperm function in <a href="/wiki/Neonates" class="mw-redirect" title="Neonates">neonates</a>.<sup id="cite_ref-:5_11-0" class="reference"><a href="#cite_note-:5-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> The cause of abnormal sperm function is thought to be due to the following mechanisms: <ul><li><a href="/wiki/Immunology" title="Immunology">Immunological</a> theory, also known as "sympathetic orchidopathia": It is thought that following injury to the testicle, the body's immune system is activated to clean up damaged cells. In the process, it creates anti-testicular cell <a href="/wiki/Antibody" title="Antibody">antibodies</a>, or proteins that cross the injured <a href="/wiki/Blood%E2%80%93testis_barrier" title="Blood–testis barrier">blood-testis barrier</a> and damage both the affected and contralateral testicles.<sup id="cite_ref-:5_11-1" class="reference"><a href="#cite_note-:5-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></li> <li>Abnormalities in <a href="/wiki/Microcirculation" title="Microcirculation">microcirculation</a> within the testicle <sup id="cite_ref-:5_11-2" class="reference"><a href="#cite_note-:5-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Reperfusion_injury" title="Reperfusion injury">Reperfusion injury</a>: This type of injury is seen in tissues that have been deprived of blood supply for a prolonged period.<sup id="cite_ref-:5_11-3" class="reference"><a href="#cite_note-:5-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></li></ul></li> <li><a href="/wiki/Gangrene" title="Gangrene">Gangrene</a>, or a type of tissue damage caused by lack of blood supply, of the testis.</li> <li><a href="/wiki/Sepsis" title="Sepsis">Sepsis</a>, in extremely rare cases (0.03%), if not treated for a long period of time, it could lead to sepsis and cause severe life-threatening infections and injuries through the blood and organs, which could lead to death.</li> <li>Recurrence of torsion may occur even after surgical fixation, although this is very unlikely.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup></li> <li>Psychological impact of losing a testicle.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Risk_factors">Risk factors</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=3" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Most of those affected with testicular torsion have no prior underlying health problems or predisposing conditions.<sup id="cite_ref-Lud2016_1-19" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> However, there are certain factors that may increase risk of testicular torsion. A larger testicle either due to normal variation or testicular tumor increases the risk of torsion.<sup id="cite_ref-PC2010_3-4" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Similarly, the presence of a mass or malignancy involving the spermatic cord can also predispose to torsion.<sup id="cite_ref-Lud2016_1-20" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Age is also an important risk factor for torsion. Torsion most commonly occurs either in the newborn or just before or during puberty.<sup id="cite_ref-AFP2013_2-13" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Testicular torsion often occurs before or during puberty, prior to complete testicular descent. <a href="/wiki/Epididymitis" title="Epididymitis">Epididymitis</a> is more commonly a postpubertal condition.<sup id="cite_ref-:0_8-1" class="reference"><a href="#cite_note-:0-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>Several congenital anatomic malformations or variations in the testicle or the surrounding structures may allow for increased scrotal rotation and increase the risk of testicular torsion.<sup id="cite_ref-PC2010_3-5" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> A congenital malformation of the <a href="/wiki/Processus_vaginalis" class="mw-redirect" title="Processus vaginalis">processus vaginalis</a> known as "bell-clapper deformity" accounts for 90% of all cases.<sup id="cite_ref-PC2010_3-6" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AFP2006_16-0" class="reference"><a href="#cite_note-AFP2006-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> In this condition, rather than the testes attaching posteriorly to the inner lining of the scrotum by the <a href="/wiki/Mesorchium" title="Mesorchium">mesorchium</a>, the mesorchium terminates early and the testis is free floating in the <a href="/wiki/Tunica_vaginalis" title="Tunica vaginalis">tunica vaginalis</a>. Other anatomic risk factors include horizontal lie of the testicle or a spermatic cord with a long intrascrotal portion.<sup id="cite_ref-PC2010_3-7" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Cryptorchidisim is also a risk factor for torsion<sup id="cite_ref-PC2010_3-8" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> with some studies proposing a 10-fold higher risk.<sup id="cite_ref-:2_17-0" class="reference"><a href="#cite_note-:2-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Testicular torsion may also be caused by trauma to the scrotum or exercise (in particular, bicycle riding);<sup id="cite_ref-:3_10-1" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> however, only about 4–8% of cases are the result of trauma.<sup id="cite_ref-Lud2016_1-21" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AFP2013_2-14" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> There is thought to be a possible genetic basis for predisposition to torsion, based on multiple published reports of familial testicular torsion.<sup id="cite_ref-:3_10-2" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> There is controversy whether cold weather months are associated with an increased risk.<sup id="cite_ref-:3_10-3" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=4" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Testicular torsion occurs when there is mechanical twisting of the spermatic cord, which suspends the testicle within the scrotum and contains the testicular artery and vein. Twisting of the cord reduces or eliminates blood flow to the testicle.<sup id="cite_ref-PC2010_3-9" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The degree of arterial and venous obstruction depends on the duration and severity of the torsion event. Typically, venous blood flow is compromised first.<sup id="cite_ref-Lud2016_1-22" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The increase in venous pressure subsequently causes decreased arterial blood flow, leading to decreased oxygen supply to the testicle, and if untreated, testicular <a href="/wiki/Infarction" title="Infarction">infarction</a>.<sup id="cite_ref-AFP2013_2-15" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>It is also believed that torsion occurring during fetal development can lead to so-called neonatal torsion or <a href="/wiki/Vanishing_testis" class="mw-redirect" title="Vanishing testis">vanishing testis</a>, and is one of the causes of an infant being born with <a href="/wiki/Monorchism" title="Monorchism">monorchism</a> (one testicle).<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Intermittent_testicular_torsion">Intermittent testicular torsion</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=5" title="Edit section: Intermittent testicular torsion"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Intermittent testicular torsion (ITT) is a less serious but chronic variant of torsion. It is characterized by intermittent scrotal or testicular pain, followed by eventual spontaneous detorsion and resolution of pain. Nausea and vomiting may also occur.<sup id="cite_ref-uribe_7-1" class="reference"><a href="#cite_note-uribe-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 150">: 150 </span></sup> Though less pressing, such individuals are at significant risk of complete torsion and possible subsequent <a href="/wiki/Orchiectomy" title="Orchiectomy">orchiectomy</a> and the recommended treatment is elective bilateral <a href="/wiki/Orchiopexy" title="Orchiopexy">orchiopexy</a>. Ninety-seven percent of patients who undergo such surgery experience complete relief from their symptoms.<sup id="cite_ref-kav_19-0" class="reference"><a href="#cite_note-kav-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 316">: 316 </span></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Extravaginal_testicular_torsion">Extravaginal testicular torsion</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=6" title="Edit section: Extravaginal testicular torsion"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Torsion occurring outside of the <a href="/wiki/Tunica_vaginalis" title="Tunica vaginalis">tunica vaginalis</a>, when the testis and <a href="/wiki/Gubernaculum" title="Gubernaculum">gubernaculum</a> can rotate freely, is termed an extravaginal testicular torsion. This type occurs exclusively in newborns, however, newborns can be affected by other testicular torsion variants as well.<sup id="cite_ref-AFP2013_2-16" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Neonates experiencing such a torsion typically present with painless scrotal swelling,<sup id="cite_ref-AFP2013_2-17" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> discoloration, and a firm, painless mass in the scrotum. Such testes are usually necrotic from birth and must be removed surgically.<sup id="cite_ref-kav_19-1" class="reference"><a href="#cite_note-kav-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 315">: 315 </span></sup> The exact cause of or specific risk factors for extravaginal torsion in this population remain unclear.<sup id="cite_ref-AFP2013_2-18" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Intravaginal_testicular_torsion">Intravaginal testicular torsion</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=7" title="Edit section: Intravaginal testicular torsion"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Intravaginal testicular torsion occurs when the testicle rotates on the spermatic cord within the tunica vaginalis.<sup id="cite_ref-AFP2013_2-19" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> This variant more commonly occurs in older children and adults. The "bell-clapper deformity," in which there is inappropriately high attachment of the tunica vaginalis over the spermatic cord and failure of the normal posterior attachment of the testicle to the inner scrotum, which allows the testicle to move freely within the tunica vaginalis and predisposes to intravaginal testicular torsion.<sup id="cite_ref-AFP2013_2-20" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Torsion_of_the_testicular_appendix">Torsion of the testicular appendix</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=8" title="Edit section: Torsion of the testicular appendix"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The testicular appendix is located in the upper pole of the testicle. It is an embryonic remnant that has no known function, but is at risk for torsion events.<sup id="cite_ref-kav_19-2" class="reference"><a href="#cite_note-kav-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> This type of torsion is the most common cause of acute scrotal pain in boys ages 7–14. Its appearance is similar to that of testicular torsion but the onset of pain is typically more gradual. <a href="/wiki/Palpation" title="Palpation">Palpation</a> reveals a small firm nodule on the upper portion of the testis which displays a characteristic "blue dot sign". This is the appendix of the testis which has become discolored and is noticeably blue through the skin. Unlike other torsions, however, the cremasteric reflex is still active. Typical treatment involves the use of over-the-counter <a href="/wiki/Analgesics" class="mw-redirect" title="Analgesics">analgesics</a> and the condition resolves within 2–3 days.<sup id="cite_ref-kav_19-3" class="reference"><a href="#cite_note-kav-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 316">: 316 </span></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Torsion_of_the_undescended_testicle">Torsion of the undescended testicle</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=9" title="Edit section: Torsion of the undescended testicle"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The undescended testis is at increased risk of testicular torsion.<sup id="cite_ref-:2_17-1" class="reference"><a href="#cite_note-:2-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> The mechanism for torsion in the undescended testicle is not fully understood, though it may be due to abnormal contractions of the cremaster muscle, which covers the testicle and spermatic cord and is responsible for raising and lowering the testicle to regulate scrotal temperature. The undescended testicle is also at higher risk for testicular tumor, which due to the increased weight and size compared to a healthy testicle can predispose to torsion.<sup id="cite_ref-:2_17-2" class="reference"><a href="#cite_note-:2-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=10" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The diagnosis should generally be made based on the presenting symptoms.<sup id="cite_ref-Lud2016_1-23" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AFP2013_2-21" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> An <a href="/wiki/Ultrasound" title="Ultrasound">ultrasound</a> can be useful when the diagnosis is unclear.<sup id="cite_ref-AFP2013_2-22" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> However, imaging should not delay surgical intervention as complications develop with prolonged <a href="/wiki/Ischemia" title="Ischemia">ischemia</a>.<sup id="cite_ref-AFP2013_2-23" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Immediate surgery is recommended regardless of imaging findings if there is a high degree of suspicion based on history and physical examination.<sup id="cite_ref-Lud2016_1-24" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AFP2013_2-24" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Given the treatment implications of testicular torsion, it is important to distinguish testicular torsion from other causes of testicular pain, such as <a href="/wiki/Epididymitis" title="Epididymitis">epididymitis</a>, which can present similarly. While both conditions can cause testicular pain, the pain of epididymitis is typically localized to the epididymis at the rear pole of the testicle. Epididymitis may also be characterized by discoloration and <a href="/wiki/Swelling_(medical)" class="mw-redirect" title="Swelling (medical)">swelling</a> of the testis, and <a href="/wiki/Fever" title="Fever">fever</a>. The cremasteric reflex in epididymitis is usually present. Testicular torsion, or more probably impending testicular <a href="/wiki/Infarction" title="Infarction">infarction</a>, can also produce a low-grade fever.<sup id="cite_ref-kav_19-4" class="reference"><a href="#cite_note-kav-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> There is often an absent or decreased <a href="/wiki/Cremasteric_reflex" title="Cremasteric reflex">cremasteric reflex</a>.<sup id="cite_ref-AFP2013_2-25" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Clinical_exam">Clinical exam</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=11" title="Edit section: Clinical exam"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The absence of the <a href="/wiki/Cremasteric_reflex" title="Cremasteric reflex">cremasteric reflex</a> in an acutely painful testicle is most indicative of testicular torsion (the twisting of the spermatic cord of the testicle makes reflexive responses all but impossible). The cremasteric reflex normally causes elevation of the testicle by stroking the inner thigh.<sup id="cite_ref-Lud2016_1-25" class="reference"><a href="#cite_note-Lud2016-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Absence is especially common in children, but its presence does not exclude a diagnosis of testicular torsion.<sup id="cite_ref-:1_6-3" class="reference"><a href="#cite_note-:1-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>On physical examination, the testis can be swollen, tender, high-riding, and with an abnormal transverse lie.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Prehn%27s_sign" title="Prehn's sign">Prehn's sign</a>, a classic physical exam finding, has not been reliable in distinguishing torsion from other causes of testicular pain such as <a href="/wiki/Epididymitis" title="Epididymitis">epididymitis</a>.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> The individual will not usually have a fever, though nausea is common.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Imaging">Imaging</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=12" title="Edit section: Imaging"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A <a href="/wiki/Ultrasound" title="Ultrasound">doppler ultrasound scan</a> of the scrotum can identify the absence of blood flow in the twisted testicle and is nearly 90% accurate in diagnosis.<sup id="cite_ref-AFP2013_2-26" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PC2010_3-10" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> It can also help distinguish torsion from <a href="/wiki/Epididymitis" title="Epididymitis">epididymitis</a>.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>Radionuclide scanning (<a href="/wiki/Scintigraphy" title="Scintigraphy">scintigraphy</a>) of the scrotum is the most accurate imaging technique, but it is not routinely available, particularly with the urgency that might be required.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> The agent of choice for this purpose is <a href="/wiki/Technetium-99m" title="Technetium-99m">technetium-99m</a> <a href="/wiki/Pertechnetate" title="Pertechnetate">pertechnetate</a>.<sup id="cite_ref-medscape_24-0" class="reference"><a href="#cite_note-medscape-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Initially it provides a <a href="/wiki/Radionuclide_angiogram" class="mw-redirect" title="Radionuclide angiogram">radionuclide angiogram</a>, followed by a static image after the radionuclide has perfused the tissue. In the healthy patient, initial images show symmetric flow to the testes, and delayed images show uniformly symmetric activity.<sup id="cite_ref-medscape_24-1" class="reference"><a href="#cite_note-medscape-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> In testicular torsion, the images may show heterogenous activity within the affected testicle.<sup id="cite_ref-medscape_24-2" class="reference"><a href="#cite_note-medscape-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Torsion_teste_aguda_(cropped).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/ac/Torsion_teste_aguda_%28cropped%29.jpg/220px-Torsion_teste_aguda_%28cropped%29.jpg" decoding="async" width="220" height="142" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/ac/Torsion_teste_aguda_%28cropped%29.jpg/330px-Torsion_teste_aguda_%28cropped%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/ac/Torsion_teste_aguda_%28cropped%29.jpg/440px-Torsion_teste_aguda_%28cropped%29.jpg 2x" data-file-width="2553" data-file-height="1649" /></a><figcaption>Image of testicular torsion</figcaption></figure> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=13" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Testicular torsion is a <a href="/wiki/Surgical_emergency" title="Surgical emergency">surgical emergency</a> that requires immediate intervention to restore the flow of blood to the testicle.<sup id="cite_ref-PC2010_3-11" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> If treated either manually or surgically within six hours, there is a high chance (approximately 90%) of saving the testicle. At 12 hours the rate decreases to 50%; at 24 hours it drops to 10%, and after 24 hours the ability to save the testicle approaches 0, although salvage of the testicle has been reported beyond 24 hours.<sup id="cite_ref-PC2010_3-12" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> About 40% of cases result in loss of the testicle.<sup id="cite_ref-AFP2013_2-27" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>With prompt diagnosis and treatment the testicle can often be saved.<sup id="cite_ref-PC2010_3-13" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Typically, when a torsion takes place, the surface of the testicle has rotated towards the midline of the body. Non-surgical correction can sometimes be accomplished by manually rotating the testicle in the opposite direction (i.e., outward, towards the thigh); if this is initially unsuccessful, a forced manual rotation in the other direction may correct the problem.<sup id="cite_ref-uribe_7-2" class="reference"><a href="#cite_note-uribe-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 149">: 149 </span></sup> The success rate of manual detorsion is not known with confidence.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2023)">citation needed</span></a></i>]</sup> </p><p>When salvage of the testicle is accomplished, long-term testicular damage is common. Testicular size is often diminished, and injury to the unaffected testicle is common.<sup id="cite_ref-:3_10-4" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The effect of a torsion event on long-term fertility is not fully understood.<sup id="cite_ref-:3_10-5" class="reference"><a href="#cite_note-:3-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>A repeat <a href="/wiki/Doppler_ultrasonography" title="Doppler ultrasonography">doppler</a> ultrasound scan may confirm restoration of blood flow to the testicle following manual detorsion. However, surgical exploration is often performed in order to assess the health and viability of the testicle. An <a href="/wiki/Orchiopexy" title="Orchiopexy">orchiopexy</a> is performed to both the affected and unaffected testicles in order to prevent recurrence. If the testis is not viable, it is removed (<a href="/wiki/Orchiectomy" title="Orchiectomy">orchiectomy</a>).<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=14" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Torsion is most frequent among adolescents with about 65% of cases presenting between 12 and 18 years of age.<sup id="cite_ref-:4_27-0" class="reference"><a href="#cite_note-:4-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> It is the most common cause of rapid onset testicular pain and swelling in people under 18 years old.<sup id="cite_ref-:4_27-1" class="reference"><a href="#cite_note-:4-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> It occurs in about 1 in 4,000 to 1 per 25,000 males per year before 25 years of age;<sup id="cite_ref-AFP2013_2-28" class="reference"><a href="#cite_note-AFP2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PC2010_3-14" class="reference"><a href="#cite_note-PC2010-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AFP2006_16-1" class="reference"><a href="#cite_note-AFP2006-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> but it can occur at any age, including infancy.<sup id="cite_ref-uribe_7-3" class="reference"><a href="#cite_note-uribe-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 149">: 149 </span></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=15" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Epididymitis" title="Epididymitis">Epididymitis</a> – can cause testicular pain and present similarly to testicular torsion.</li> <li><a href="/wiki/Ovarian_torsion" title="Ovarian torsion">Ovarian torsion</a> – equivalent condition in females.</li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Testicular_torsion&action=edit&section=16" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Lud2016-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Lud2016_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Lud2016_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Lud2016_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Lud2016_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Lud2016_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Lud2016_1-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Lud2016_1-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Lud2016_1-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Lud2016_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Lud2016_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-Lud2016_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-Lud2016_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-Lud2016_1-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-Lud2016_1-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-Lud2016_1-14"><sup><i><b>o</b></i></sup></a> <a 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"The acute scrotum". <i>Emerg. Med. Clin. North Am</i>. <b>6</b> (3): 521–46. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0733-8627%2820%2930545-9">10.1016/S0733-8627(20)30545-9</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/3292226">3292226</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Emerg.+Med.+Clin.+North+Am.&rft.atitle=The+acute+scrotum&rft.volume=6&rft.issue=3&rft.pages=521-46&rft.date=1988-08&rft_id=info%3Adoi%2F10.1016%2FS0733-8627%2820%2930545-9&rft_id=info%3Apmid%2F3292226&rft.aulast=Edelsberg&rft.aufirst=JS&rft.au=Surh%2C+YS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATesticular+torsion" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External 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(";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1434575" class="extiw" title="d:Q1434575">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/N44">N44</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=608.2">608.2</a></li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/187400">187400</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D013086">D013086</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb12984.htm">12984</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/81996005">81996005</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000517.htm">000517</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/2780-overview">med/2780</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Male_diseases_of_the_pelvis_and_genitals" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Male_diseases_of_the_pelvis_and_genitals" title="Template:Male diseases of the pelvis and genitals"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Male_diseases_of_the_pelvis_and_genitals" title="Template talk:Male diseases of the pelvis and genitals"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Male_diseases_of_the_pelvis_and_genitals" title="Special:EditPage/Template:Male diseases of the pelvis and genitals"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Male_diseases_of_the_pelvis_and_genitals" style="font-size:114%;margin:0 4em"><a href="/wiki/Male_genital_disease" title="Male genital disease">Male diseases</a> of the <a href="/wiki/Pelvis" title="Pelvis">pelvis</a> and <a href="/wiki/Sex_organ" title="Sex organ">genitals</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Internal</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Testicular_disease" class="mw-redirect" title="Testicular disease">Testicular</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Orchitis" title="Orchitis">Orchitis</a></li> <li><a href="/wiki/Hydrocele_testis" title="Hydrocele testis">Hydrocele testis</a></li> <li><a href="/wiki/Testicular_cancer" title="Testicular cancer">Testicular cancer</a></li> <li><a class="mw-selflink selflink">Testicular torsion</a></li> <li><a href="/wiki/Male_infertility" title="Male infertility">Male infertility</a> <ul><li><a href="/wiki/Aspermia" title="Aspermia">Aspermia</a></li> <li><a href="/wiki/Asthenozoospermia" title="Asthenozoospermia">Asthenozoospermia</a></li> <li><a href="/wiki/Azoospermia" title="Azoospermia">Azoospermia</a></li> <li><a href="/wiki/Hyperspermia" title="Hyperspermia">Hyperspermia</a></li> <li><a href="/wiki/Hypospermia" title="Hypospermia">Hypospermia</a></li> <li><a href="/wiki/Oligospermia" title="Oligospermia">Oligospermia</a></li> <li><a href="/wiki/Necrospermia" title="Necrospermia">Necrospermia</a></li> <li><a href="/wiki/Teratospermia" title="Teratospermia">Teratospermia</a></li></ul></li> <li><a href="/wiki/Ectopic_testis" title="Ectopic testis">Ectopic testis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epididymis" title="Epididymis">Epididymis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Epididymitis" title="Epididymitis">Epididymitis</a></li> <li><a href="/wiki/Spermatocele" title="Spermatocele">Spermatocele</a></li> <li><a href="/wiki/Hematocele" title="Hematocele">Hematocele</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Prostate" title="Prostate">Prostate</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Prostatitis" title="Prostatitis">Prostatitis</a> <ul><li><a href="/wiki/Acute_prostatitis" title="Acute prostatitis">Acute prostatitis</a></li> <li><a href="/wiki/Chronic_bacterial_prostatitis" title="Chronic bacterial prostatitis">Chronic bacterial prostatitis</a></li> <li><a href="/wiki/Chronic_prostatitis/chronic_pelvic_pain_syndrome" title="Chronic prostatitis/chronic pelvic pain syndrome">Chronic prostatitis/chronic pelvic pain syndrome</a></li> <li><a href="/wiki/Asymptomatic_inflammatory_prostatitis" title="Asymptomatic inflammatory prostatitis">Asymptomatic inflammatory prostatitis</a></li></ul></li> <li><a href="/wiki/Benign_prostatic_hyperplasia" title="Benign prostatic hyperplasia">Benign prostatic hyperplasia</a></li> <li><a href="/wiki/Prostate_cancer" title="Prostate cancer">Prostate cancer</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Seminal_vesicle" class="mw-redirect" title="Seminal vesicle">Seminal vesicle</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Seminal_vesicle#Inflammation" class="mw-redirect" title="Seminal vesicle">Seminal vesiculitis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">External</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_penis" title="Human penis">Penis</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Balanitis" title="Balanitis">Balanoposthitis / Balanitis</a> <ul><li><i><a href="/wiki/Balanitis_plasmacellularis" title="Balanitis plasmacellularis">Balanitis plasmacellularis</a></i></li> <li><i><a href="/wiki/Pseudoepitheliomatous_keratotic_and_micaceous_balanitis" title="Pseudoepitheliomatous keratotic and micaceous balanitis">Pseudoepitheliomatous keratotic and micaceous balanitis</a></i></li></ul></li> <li><a href="/wiki/Phimosis" title="Phimosis">Phimosis</a></li> <li><a href="/wiki/Paraphimosis" title="Paraphimosis">Paraphimosis</a></li> <li><a href="/wiki/Priapism" title="Priapism">Priapism</a></li> <li><a href="/wiki/Sexual_dysfunction" title="Sexual dysfunction">Sexual dysfunction</a> <ul><li><a href="/wiki/Erectile_dysfunction" title="Erectile dysfunction">Erectile dysfunction</a></li></ul></li> <li><a href="/wiki/Spontaneous_orgasm" title="Spontaneous orgasm">Spontaneous orgasm</a></li> <li><a href="/wiki/Peyronie%27s_disease" title="Peyronie's disease">Peyronie's disease</a></li> <li><a href="/wiki/Penile_cancer" title="Penile cancer">Penile cancer</a></li> <li><a href="/wiki/Penile_fracture" title="Penile fracture">Penile fracture</a></li> <li><a href="/wiki/Lichen_sclerosus" title="Lichen sclerosus">Balanitis xerotica obliterans</a></li> <li><a href="/wiki/Persistent_genital_arousal_disorder" title="Persistent genital arousal disorder">Persistent genital arousal disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Scrotum" title="Scrotum">Scrotum</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Fournier_gangrene" title="Fournier gangrene">Fournier gangrene</a></li> <li><a href="/wiki/Varicocele" title="Varicocele">Varicocele</a></li> <li><a href="/wiki/Pneumoscrotum" 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