Abstract:

Testicular torsion has a bimodal distribution, namely in the early neonatal period and in adolescent period. Internal spermatic artery is the longest artery of the human body. For that reason, it makes the testicle a good candidate to turn around it’s vascular pedicle. Neonatal testicular torsion is a difficult condition to diagnose and it is more difficult to make a decision to operate in obscure cases, especially with an accompanying systemic disease. A-40-hour old newborn with respiratory distress and Hydrops fetalis was consulted for abdominal distension, scrotal edema and swelling. On physical examination, there was no scrotal transluminiation, but both scrotal and inguinal region was tender with palpation in both sides. Both testicles were hard to palpation and situated in high-horizontal position. Right testicle was approximately 1x1 cm, and left testicle was approximately 2x2 cm in size. Plain abdominal xray was normal. Based on physical examination; the patient underwent immediate surgery with a diagnosis of bilateral testicular torsion. At the operation we found the left testicle was rotated 540 degree, and right one was rotated 720 degree on their pedicle. Both testes were detorsioned manually. After detorsion, suspicious viability on both testicle were identified and bilateral orchiopexy were performed. Two months after operation, color doppler ultrasound showed diminished but present testicular arterial flow. Since we mostly see emergency conditions after regular working-hours, especially in acute scrotum cases, we have to evaluate the patient without any spesific diagnostic tool like Color doppler Ultrasonography. However, any suspicion about testicular torsion should emerge the surgeon to perform surgical exploration to prevent testicular necrosis which its future consequences could be catastrophic for both patient and parents as seen in our case.

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