Habib Murad, Amjad Muhammad Bin, Ahmed Mansoor
Department of Paediatric surgery, The Children's hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
Islamabad Medical and Dental College, Islamabad, Pakistan.
Case Rep Perinat Med. 2022 Dec 20;12(1):20220013. doi: 10.1515/crpm-2022-0013. eCollection 2023 Jan.
Intrauterine testicular torsion is extremely rare and the exact cause remains largely unknown. It is the result of an ischemic insult intrauterine, which presents as either extra-vaginal or intravaginal testicular torsion. Urgent surgical exploration and fixating the contralateral testis is key in the management of this condition.
We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children's hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed.
Intrauterine testicular torsion should be treated as a surgical emergency. We advocate early recognition of intrauterine testicular torsion, alongside surgical exploration and simultaneous contralateral orchidopexy.
宫内睾丸扭转极为罕见，确切病因尚不清楚。它是宫内缺血性损伤的结果，表现为阴囊外或阴囊内睾丸扭转。紧急手术探查并固定对侧睾丸是治疗该病的关键。
我们在此报告一例儿童医院收治的2日龄新生儿，其出生时即有右侧阴囊肿胀。患儿在一家私立医院足月剖宫产出生。到达急诊科时，他水分充足，室温下皮肤呈粉红色，灌注良好。检查发现右侧睾丸肿大、紧张、无压痛，明显发红，表面皮肤有擦伤。右侧透光试验阴性，对侧睾丸透光试验阳性。双侧疝孔正常。腹股沟阴囊区域的多普勒超声检查发现右侧睾丸肿大（15.6×9.4毫米），呈不均匀低回声质地，睾丸网明显，彩色多普勒分析无血流信号。遂进行紧急阴囊探查。术中发现右侧睾丸明显坏死，睾丸阴囊内扭转，伴有少量鞘膜积液。行右侧睾丸切除术和对侧睾丸固定术。
宫内睾丸扭转应作为外科急症治疗。我们主张早期识别宫内睾丸扭转，并进行手术探查和同期对侧睾丸固定术。
