Patoulias Dimitrios, Farmakis Konstantinos, Kalogirou Maria, Patoulias Ioannis
Department of Internal Medicine, GH of Veria, Veria, Greece.
Folia Med Cracov. 2017;57(2):53-62.
Transient testicular torsion (TTT) occurs when the torsion of the spermatic cord is reversed automatically within few minutes, with subsequent restoration of the blood ow to the suffering testis. e main clinical manifestation is acute scrotal pain, which resolves within a short period of time, usually few minutes. In 25% of patients su er from nausea and vomiting, besides the scrotal discomfort. Episodes of torsion can be repeated 1-30 times, leading progressively to development of ischemic trauma of the testis, while in 30-61% of all cases they constitute a precursor of testicular torsion. From January, 2016 to December, 2016, 11 patients in total were admitted to the Emergency Department due to acute scrotal pain that lasted a few minutes (1-5 minutes in most), which had already elapsed at the time of their admission, accompanied with nausea in all patients and vomiting in 5 of them. No swelling or rubor of the scrotum was revealed during physical examination, while in 9 patients it was observed that the suffering testis had transverse orientation. Ultrasonography was negative for pseudotumor or Whirlpool sign, while transverse orientation of the testis was confirmed in 9 patients. All the patients underwent surgical investigation of the suffering hemiscrotum, while Bell Clapper Deformity was found in 9 patients. Fixation of the suffering testis to the mesoscrotal diaphragm with 3 separate sutures by using non-absorbable suture followed. By the same surgical approach, the contralateral hemiscrotum was also investigated. Bilateral high adhesion of the tunica vaginalis was found in 8 out of 9 patients, in whom preventive unilateral orchidopexy was performed. All the patients are followed-up on a 6-month basis, without report of a similar, transient episode of acute scrotal pain. TTT should always be included in differential diagnosis in cases of acute scrotal pain in the past, with transverse orientation of the suffering testis. Prompt diagnosis and early treatment of the subject anatomic deformity (Bell Clapper Deformity) prevents the ischemic consequences on testicular parenchyma due to either recurrent episode of TTT or as a consequence of intravaginal testicular torsion.
短暂性睾丸扭转（TTT）是指精索扭转在几分钟内自动复位，随后患侧睾丸血流恢复。主要临床表现为急性阴囊疼痛，通常在几分钟内短时间内缓解。25%的患者除阴囊不适外，还伴有恶心和呕吐。扭转发作可重复1至30次，逐渐导致睾丸缺血性损伤，而在所有病例中，30%至61%的扭转发作是睾丸扭转的先兆。2016年1月至2016年12月，共有11例患者因急性阴囊疼痛（多数持续1至5分钟）就诊于急诊科，就诊时疼痛已缓解，所有患者均伴有恶心，其中5例伴有呕吐。体格检查未发现阴囊肿胀或发红，9例患者观察到患侧睾丸呈横向位置。超声检查未发现假瘤或漩涡征，9例患者证实睾丸呈横向位置。所有患者均接受了患侧阴囊的手术探查，9例患者发现钟摆畸形。随后用不可吸收缝线通过3根单独的缝线将患侧睾丸固定于阴囊中隔。通过相同的手术方法，对侧阴囊也进行了探查。9例患者中有8例发现双侧鞘膜高度粘连，对其中进行了预防性单侧睾丸固定术。所有患者均每6个月随访一次，未报告类似的短暂性急性阴囊疼痛发作。对于既往有急性阴囊疼痛且患侧睾丸呈横向位置的病例，鉴别诊断时应始终考虑TTT。对该解剖畸形（钟摆畸形）进行及时诊断和早期治疗，可防止因TTT反复发作或阴囊内睾丸扭转而导致睾丸实质的缺血性后果。
