Testicular torsion after laparoscopic appendectomy: salvage by spermatic cord heparin flush and testicular decompression - a case report and literature review.

BACKGROUND

Testicular torsion is defined as an acute scrotal emergency that occurs in adolescents. It requires intervention within 6 h to avoid necrosis due to ischemia of the testis caused by seminal torsion. The etiology of testicular torsion is mostly associated with anatomical abnormalities, such as pendulum malformation. The clinical presentation is characterized by sudden onset of scrotal pain. Ultrasound is used in combination with the TWIST scoring system to improve diagnostic accuracy. Early surgical exploration is central to treatment; however, delayed diagnosis and treatment lead to an orchiectomy rate of up to 71%. Perioperative pain, inflammatory irritation, or prolonged bed rest may induce torsion; however, reports of postoperative secondary testicular torsion are rare and require clinical vigilance.

CASE PRESENTATION

A 14-year-old male patient presented with sudden onset of right scrotal swelling and pain 24 h after undergoing laparoscopic surgery for acute appendicitis. A detailed ultrasonographic examination revealed a significant reduction in blood flow to the patient's right testis, leading to a diagnosis of 720° testicular torsion with infarction. The patient's family expressed a preference for preservation of the testis, and thus, following sodium heparinisation of the spermatic cord, the incision of testicular tunica albuginea was performed to achieve testicular decompression. Postoperative and intraoperative evaluations demonstrated restoration of blood flow. However, a 3-month follow-up revealed atrophy of the affected testis (1.9 × 1.3 × 1.1 cm) with a 55% reduction in size.

DISCUSSION AND CONCLUSION

This rare instance of postoperative testicular torsion underscores the necessity for enhanced perioperative monitoring of the genital region, particularly in cases involving anatomical abnormalities and risk factors. Despite the short-term benefits of innovative interventions in improving blood supply, the resultant ischemia-reperfusion injury led to irreversible atrophy. Combining ultrasound with TWIST scoring has been shown to enhance the diagnostic process; however, its sensitivity to early torsion remains limited, necessitating vigilance for dynamic changes. The preservation of the necrotic testis has been demonstrated to reduce psychological stress; however, the long-term risks of atrophy, infertility, and malignancy require adequate information about prognosis.