LAUSR

Introduction Testicular torsion is an acute surgical emergency, with an approximate 6 hour window from onset of symptoms, to irreversible damage to the testicle.1 Trauma associated testicular torsion is a well recognised complication of blunt scrotal trauma, accounting for 4–8% of all torsions.2,3 Delays in recognition of the condition, and subsequent delayed surgical exploration, may necessitate orchidectomy, and risks impairment of future fertility.4Patient factors associated with delay in presentation include embarrassment around pain in the genitals, and lack of awareness of the condition.5 Case description A 14 year old Irish boy, with a previous history of bilateral retractile testes, presented to the Emergency department with a three day history of severe left sided scrotal pain and swelling following a traumatic injury to the perineum. The patient was cycling off-road three days prior to presentation, and suffered a cross-bar related injury to the scrotum and perineum. He felt immediate left testicular pain, however believed this to be related to bruising of his testicle. The pain progressively worsened over the following three days, and presented to hospital once the pain had become unbearable. Examination demonstrated a tender, erythematous, and swollen left hemiscrotom with an absent cremasteric reflex on the left side. The right testicle was retractile, but present within the right hemiscrotom, with a positive cremasteric reflex. US of the scrotom demonstrated an enlarged, oedematous left testicle, with absent internal vasculature, and a normal appearing right testicle. At operation, the left testicle was found to be necrotic and non-viable, and so we proceeded with a left orchidectomy. After discussion with his parents, we decided to proceed with a right sided orchidopexy with three-point fixation of his remaining testicle. The patient was discharged home later that day on a course of oral antibiotics. Discussion Time is of utmost importance in cases of testicular torsion, with early presentation, and early surgical exploration the most important factors in testicular salvage.3 It is easy to attribute post-traumatic testicular pain and swelling to the initial insult, however, a high index of suspicion is required to out-rule trauma associated testicular torsion. Early education around testicular health, an understanding that scrotal pain requires swift medical evaluation, and that delays in evaluation may impair future fertility, are important messages to convey to paediatric populations, and should be included in sexual health education for males.