Which history is characteristic of testicular torsion?

Updated: Oct 30, 2020
  • Author: Oreoluwa I Ogunyemi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Intravaginal testicular torsion produces a sudden onset of severe unilateral scrotal pain followed by inguinal and/or scrotal swelling. Pain may lessen as the necrosis becomes more complete. Gradual onset of pain is an uncommon presentation. Torsion can occur with sports or physical activity, can be related to trauma in 4-8% of cases, [16] or can develop spontaneously.

Approximately one third of patients also have gastrointestinal upset with nausea and vomiting. In the pediatric population, nausea and vomiting has a positive predictive value of greater than 96%. [19] Duration of pain of less than 6 hours, fever, vomiting, history of trauma or activities, absence of cremasteric reflex, and abnormal testicle direction have all been determined to be significantly associated with a diagnosis of testicular torsion. [20]

Patients rarely report voiding difficulties or painful urination.

In some patients, scrotal trauma or other scrotal disease (including torsion of appendix testis or epididymitis) may precede the occurrence of subsequent testicular torsion. Patients may describe previous episodes of recurrent acute scrotal pain that has resolved spontaneously. [21] This history is highly suggestive of intermittent torsion and detorsion of the testicle.

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