A 21-year-old engineering student narrowly avoided the removal of a testicle after an emergency procedure restored blood flow following a complete loss of circulation caused by testicular torsion.
A sudden bout of severe pain in the scrotum, accompanied by nausea and vomiting, may not always be dismissed as a passing discomfort. In some cases, it can signal testicular torsion, a medical emergency in which the spermatic cord twists and cuts off the blood supply to a testicle. Without prompt treatment, the affected organ can suffer irreversible damage.
A 21-year-old engineering student recently experienced the condition after developing intense pain and swelling in his left scrotum. A Doppler ultrasound revealed testicular torsion with a complete interruption of blood flow. He was rushed for emergency surgery, where doctors untwisted the spermatic cord and restored circulation, helping save the testicle and avoid its removal.
During the procedure, the affected testicle initially appeared dusky, indicating compromised blood supply. After the cord was untwisted and warm saline was applied, its colour returned to normal, suggesting recovery of circulation. The approximately 20-minute operation was followed by an uneventful recovery, and the patient was discharged the next day. A subsequent Doppler examination showed normal blood flow.
According to doctors, testicular torsion occurs when the spermatic cord, which carries blood vessels to the testicle, twists around itself. The resulting loss of blood supply can rapidly damage the tissue. The condition is most common among adolescents and young men, although it can occur at other ages as well.
“The condition requires immediate surgical treatment, ideally within about four to six hours of symptom onset, as the chances of permanent damage increase with the duration of blood-flow interruption,” says Dr Vikas Bhise, a urologist who treated the patient at Medicover Hospitals, Navi Mumbai.
Importantly, testicular torsion does not necessarily follow an injury or strenuous physical activity explained Dr Bhise. It can occur spontaneously, including during sleep or while resting. An anatomical variation known as the bell-clapper deformity, in which the testicle has greater freedom to rotate within the scrotum, can increase the risk.
Sudden, severe pain in one testicle is the most important warning sign. Other symptoms may include swelling, tenderness, nausea, vomiting, pain in the lower abdomen or a testicle that appears higher than usual.
The symptoms can sometimes resemble those of other conditions, making urgent medical assessment essential. A clinician may conduct a physical examination and recommend a Doppler ultrasound to assess blood flow.
Doctors explain that treatment typically involves emergency surgical exploration to untwist the spermatic cord and assess whether the testicle has recovered. Once blood flow is restored, the testicle is generally secured with stitches in a procedure called orchidopexy to reduce the risk of recurrence. The other testicle is usually secured as well because the underlying anatomical predisposition may affect both sides.
If the affected tissue has sustained irreversible damage and is no longer viable, removal of the testicle, known as an orchiectomy, may be necessary, explain doctors.
The outcome of testicular torsion depends substantially on how quickly the blood supply is restored, although the extent of twisting and individual circumstances also influence recovery. While surgery within the first few hours offers the best chance of saving the testicle, the possibility of successful treatment does not disappear after that window.
“Anyone who develops sudden, severe testicular pain should not wait for the pain to settle or attempt to manage it at home. Immediate assessment in an emergency department is essential,” Dr Bhise says.
