Testicular Torsion

Testicular torsion occurs when the spermatic cord twists and obstructs venous outflow and arterial inflow to the testis. The testis is then trapped behind a twisted vascular cord: blood cannot enter adequately, waste products cannot leave, and ischemic injury develops quickly. Untreated ischemia can progress to infarction, leaving the testis non-viable. This is a time-critical surgical emergency, not a condition to observe for symptom progression. Testicular salvage exceeds 90% when surgery occurs within 6 hours of symptom onset but falls to less than 50% after 12 hours. The clock starts when pain began, not when the patient arrives or when imaging is completed. Torsion has a bimodal distribution, occurring most often in neonates and adolescents. A sudden scrotal complaint in either group deserves urgent attention, even when the patient is embarrassed, minimizes symptoms, or initially describes the pain as lower abdominal rather than scrotal.