Korean J Urol.  2013 Oct;54(10):718-720.

Missed Spermatic Cord Torsion in an Old Man

• Seo YM
• Myung NH
• Hong JH

Abstract

The fate of testicular salvage in spermatic cord torsion depends on the duration of ischemia and the degree of torsion. Even though spermatic cord torsion (SCT) can occur at any age, it is rarely reported in older patients. If the physician does not pay close attention to this unusual situation, the lack of suspicion for SCT may result in a missed or delayed diagnosis. We report a very uncommon case of missed SCT occurring in a 63-year-old man.

Keyword

Age groups; Spermatic cord torsion; Testis

MeSH Terms

Delayed Diagnosis
Humans
Ischemia
Middle Aged
Spermatic Cord
Spermatic Cord Torsion
Testis

Figure

• 

  FIG. 1 (A) Gray-scale imaging demonstrates that the right testis shows a heterogeneous echotexture with thickening of the scrotal wall. A twisted cord structure (white arrows) is identified as an echogenic extratesticular mass. (B) Color Doppler ultrasonography shows the complete absence of detectable flow inside the right testis. T, testis.

• 

  FIG. 2 (A) Gross appearance of the specimen. The cord appears as a twisted breadstick within the thickened vaginalis. (B) Microscopic finding. Hemorrhagic testicular infarct of this case reveals typical coagulative necrosis of almost the entire seminiferous tubules in the background of stromal hemorrhage (H&E, ×100).

Reference

1. Anderson JB, Williamson RC. Testicular torsion in Bristol: a 25-year review. Br J Surg. 1988; 75:988–992.

2. Cuckow PM, Frank JD. Torsion of the testis. BJU Int. 2000; 86:349–353.

3. Ellati RT, Kavoussi PK, Turner TT, Lysiak JJ. Twist and shout: a clinical and experimental review of testicular torsion. Korean J Urol. 2009; 50:1159–1167.

4. Cummings JM, Boullier JA, Sekhon D, Bose K. Adult testicular torsion. J Urol. 2002; 167:2109–2110.

5. Allen B, Ball AJ, Desai A. Delayed presentation of acute scrotum: a rare age for torsion. Intern Emerg Med. 2010; 5:553–554.

6. Seaman EK, Sawczuk I. Testis tumor in an adult presenting with torsion of testis. Urology. 1993; 42:453–454.

7. Stavros A, Rapp C, McGrath J. Color duplex sonography of acute scrotal pain. In : Bluth EI, Arger PH, Benson CB, Ralls PW, Siegel MJ, editors. Ultrasound: a practical approach to clinical problems. New York: Thieme;2000. p. 135–152.

8. Kalfa N, Veyrac C, Lopez M, Lopez C, Maurel A, Kaselas C, et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol. 2007; 177:297–301.