An unusual presentation of testicular torsion in children: a single - centre retrospective study.

Introduction: The aim of this study was to investigate demographic and clinical characteristics and outcomes of the treatments of the patients with an unusual presentation of the testicular torsion (TT) and to clarify their peculiarities.

Material And Methods: From January 1999 until December 2017, the case records of 149 patients who underwent surgery for TT were retrospectively reviewed. Out of that number, 25 patients were identified with unusual presentation of an acute scrotum (14 patients who presented with an abdominal pain only, and 11 who presented with testicular torsion in inguinal canal).

Results: The median age of all children with TT at the time of surgery was 14 years. The duration of the symptoms varied substantially and ranged from 1 hour to 120 hours with a median of 6 hours, with only 63 (42.3%) out of the 149 patients staying below the golden 6 hours. Only 2/11 (18.2%) children of the inguinal group and 5/14 (35.71%) children of the abdominal group presented within 6 hours. In the group with inguinal TT the median age was 13 years with the median duration of symptoms of 24 hours. The symptoms were mostly abdominal pain (90.9%), followed by groin pain (45.5%) and nausea (45.5%). In 6 out of 11 children, the first physical examination did not include a genital examination. In the group with abdominal pain, the a median age was 13 years, with median duration of symptoms of 17 hours. The symptoms were limited, besides the abdominal pain, to groin pain (42.8%) and nausea (50%). In 9 out of 14 children, the first physical examination did not include a genital examination. The rate of orchidectomy in the inguinal TT group was 54.5%, while in the abdominal group 57.1%.

Conclusion: Testicular torsion, particulary in regard to torsion in the inguinal canal or presenting dominantly with abdominal pain can be easily misdiagnosed, but needs to be recognized on time, to salvage the affected testicle. The complete physical examination, including the genital examination, needs to be performed in each male patient presenting with lower abdominal or groin pain.