謝育哲、劉建良、黃冠華

奇美醫學中心 外科部 泌尿科

 

Neonatal testicular torsion, defined as torsion occurring within the first 30 days of life, is a rare occurrence. However, it can result in vascular compromise leading to testicular ischemia and injury, and if not corrected, necrosis and testicular nonviability. We described a case of neonatal testicular torsion, a two-day-old infant was diagnosed with testicular torsion and received orchiectomy(torsion side) and orchiopexy(health side) subsequently.

 

A 2-day-old neonate, left testis swelling was noted for 12 hours. He was brought to our ER, where echo showed heterogenous left testis, twisting appearence of its pedicle and absence of internal vascularity on both color Doppler and spectral analysis. Under the impression of testicular torsion, he was admitted and received scrotal exploration subsequently. Operative finding showed remarkable gangrene change of left testis. No obvious torsion but stenosis of spermatic cord was also noticed. Orchiectomy was performed for left side testis (torsion side). Right testis was intact, orchiopexy was performed to prevent asynchronous contralateral testicular torsion. No complication was noted during operation. After operation, fair appetite, fair activity, and clear wound was noted. He was arranged discharge and OPD follow-up on POD3.

 

Management of neonatal testicular torsion is a matter of controversy. Although the possibility of salvaging the involved testicle is very low, howerer, it is hard to justify a passive approach to a condition resulting in such a devastating condition as anorchia. Time should not be wasted in doing investigations because imaging studies have a limited role in preoperative management. We should explore the affected side promptly to confirm the diagnosis and to fix or remove the affected testicle. The contralateral scrotum also should be explored because of the risk of asynchronous contralateral testicular torsion.