Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
The Abdomen
Laparotomy and Abdominal Trauma
Labarotomy
Abdominal trauma
Acute Abdominal Conditions
Assessment and diagnosis
Intestinal obstruction
Peritonitis
Stomac and duodenum
Gallbladder
Appendix
Abdominal Wall Hernia
Groin hernia
Surgical repair of inguinal hernia
Surgical repair of femoral hernia
Surgical treatment of strangulated groin hernia
Surgical repair of umbilical and para-umbilical hernia
Surgical repair of epigastric hernia
Incisional hernia
Urinary Tract and Perineum
The urinary bladder
The male urethra
The perineum
The Male Urethra
 


> URETHRAL STRICTURE
> THE PREPUCE
> PARAPHIMOSIS
> TORSION OF THE TESTIS
> SCROTAL HYDROCOELE
> VASECTOMY





Torsion of the testis is seen most commonly in children and adolescents. The predisposing factors are congenital scrotal abnormalities which include:

:: Long mesorchium, a horizontal lie of the testis within the scrotum
:: Ectopic testis.

The presentation is one of sudden onset of lower abdominal pain, pain in the affected testis and vomiting. The affected testis and cord are markedly tender. The testis is often swollen and drawn upwards. Important differential diagnoses
include:

:: Epididymorchitis: the patient often has urinary symptoms, including urethral discharge
:: Testicular tumour: the onset is not sudden.

Treatment

The treatment is urgent surgery to:

:: Untwist the torsion
:: Fix the testis
:: Explore the other side and similarly fix the testis to prevent the normal testis from undergoing torsion subsequently.


Operate on torsion of the testis without delay. Make every effort to save the testis. Do not rush into performing orchidectomy even if, at exposure, you think that the testis is already gangrenous. Always ask for a second opinion in
such circumstances.

Wrap the affected testis with warm wet swabs, wait for a minimum of 5 minutes and check for any improvement in colour. Do not hurry this stage;
give yourself plenty of time, provided you have already untwisted the torsion. However, if the testis is dead, it should be removed, as autoimmune responses can result in loss of function of the other testis.

> URETHRAL STRICTURE
> THE PREPUCE
> PARAPHIMOSIS
> TORSION OF THE TESTIS
> SCROTAL HYDROCOELE
> VASECTOMY



Top of Page

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
  Kep Points  
In torsion, the testicle can
become gangrenous in 4 hours; treatment is thus an emergency
The non-affected side should be fixed at the same time as the subsequent incidence of torsion
on the opposite side is high

 
When the testis is dead,
orchidectomy should be
performed to protect the other testis from loss due to
autoimmune disease
 
One testicle is enough for normal fertility.