Pogorelić Zenon, Jukić Miro, Škrabić Veselin, Mrklić Ivana, Fridl Vidas Vesna, Jurić Ivo, Furlan Dubravko
Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.
University of Split, School of Medicine, Split, Croatia.
Acta Medica (Hradec Kralove). 2017;60(3):120-123. doi: 10.14712/18059694.2018.4.
Testicular torsion is a urological emergency. If not recognized in time, this condition may result in ischaemic injury and loss of testis. Simultaneous bilateral neonatal testicular torsion is extremely rare and is usually misdiagnosed.
We report a case of a male newborn, who presented with bilateral scrotal swelling and redness of the scrotum. Doppler ultrasound supported the diagnosis of bilateral testicular torsion, with an absent blood flow signal on the right side and a weak signal on the left side. Testicular exploration through scrotal incision was performed and bilateral testicular torsion was found. Right testis was grossly gangrenous, and right orchiectomy was performed. Left testicle was dark but showed recovery after detorsion with some bleeding from incised tunica albugenia. Fixation of the left testicle was performed. At six month follow-up, the left testis showed signs of atrophy and hormonal assay showed very low testosterone and elevated LH and FSH, suggesting hypogonadism.
Management of neonatal testicular torsion is a matter of controversy. Testicular torsion results into acute ischemia and urgent surgical exploration is the key point of management. Although the possibility of salvaging the involved testicles is usually very low it is hard to justify a passive approach to a bilateral torsion resulting in such a devastating condition as anorchia.
睾丸扭转是一种泌尿外科急症。如果不能及时识别，这种情况可能导致缺血性损伤和睾丸丧失。双侧新生儿同时发生睾丸扭转极为罕见，通常会被误诊。
我们报告一例男性新生儿，其表现为双侧阴囊肿胀和阴囊发红。多普勒超声支持双侧睾丸扭转的诊断，右侧无血流信号，左侧为弱信号。通过阴囊切口进行睾丸探查，发现双侧睾丸扭转。右侧睾丸严重坏疽，遂行右侧睾丸切除术。左侧睾丸颜色暗黑，但扭转复位后显示恢复，白膜切开处有一些出血。对左侧睾丸进行了固定。在六个月的随访中，左侧睾丸显示出萎缩迹象，激素检测显示睾酮水平极低，促黄体生成素（LH）和促卵泡生成素（FSH）升高，提示性腺功能减退。
新生儿睾丸扭转的处理存在争议。睾丸扭转导致急性缺血，紧急手术探查是处理的关键。尽管挽救受累睾丸的可能性通常很低，但对于双侧扭转导致无睾这种毁灭性情况采取消极态度是难以说得通的。
