Testis and epididymis
Non-neoplastic lesions
Torsion

Author: Rafael Jimenez, M.D. (see Authors page)

Revised: 31 May 2017, last major update March 2012

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: torsion[title] spermatic cord[title]
Cite this page: Torsion. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testistorsion.html. Accessed October 20th, 2017.
Definition / general
  • May cause testicular infarct if not treated quickly
  • Usually occurs in first year of life, also towards puberty due to trauma or violent movement
  • Associated with incomplete testicular descent, absent scrotal ligaments, absent gubernaculum testis or testicular atrophy causing testis to be abnormally mobile
  • In 2/3 of cases, occurs in intravaginal portion of spermatic cord (i.e. within tunica vaginalis); extravaginal torsion associated with infancy
  • Thick walled arteries remain patent, so get vascular engorgement and venous infarction (enlarged and painful testis)
  • Torsion must last at least 6 - 24 hours to cause an infarct
  • Torsion without an infarct causes infertility proportionate to duration of torsion
Treatment
  • Untwist and fix testis to dartos muscle or orchiectomy
  • Note: opposite testis should be fixed to dartos muscle as preventive measure
Microscopic (histologic) images

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Testicular torsion and infarction

Microscopic (histologic) description
  • Up to 6 hours - venous congestion and interstitial hemorrhage
  • Later neutrophils in capillaries; at 4 days see hemorrhagic infarction and coagulative necrosis
  • Later granulation tissue; years later may see fibrosis and calcification
Differential diagnosis
  • Testicular pain due to Henoch–Schönlein purpura (small vessel vasculitis)
  • Torsion of testicular appendage: 90% of time involves appendix testis (dramatic pain out of proportion to minute size of appendage) 10% of time involves epididymis