Late-diagnosed complete intravaginal testicular torsion with preserved blood flow and viable testis in an adolescent

Abstract

To the Editor, Testicular torsion (TT) is an emergency caused by the twisting of the spermatic cord. In addition to being complete, TT can be partial or intermittent. The degree of spermatic cord twist in partial or incomplete TT is < 360°. In intermittent TT, the degree of spermatic cord twist is ≥ 360°, but spontaneous resolution occurs after a short time. In the mentioned forms of TT, color Doppler ultrasonography (CDS) shows a subtle decreased blood flow or flow that appears symmetrical with the contralateral testis.1 In contrast, complete TT results in testicular ischemia due to compromised blood flow to the affected testis. The resulting ischemia can be seen on the CDS as absent or markedly diminished blood perfusion.2 However, cases of TT with preserved intratesticular blood flow on CDS have also been reported, primarily in patients with partial or intermittent TT with recurrent testicular pain3,4 or, as in our case, with a complete TT. The duration of symptoms and the degree of twisting of the spermatic cord are the main predictors of the vitality of the affected testis.5 However, some anatomical variables may be associated with prolonged preservation of blood flow in TT.4 Bentley et al suggested that a thicker spermatic cord and fixation of the testis allow testicular blood flow to be maintained for an extended period despite spermatic cord torsion.4