TWISTED FATE: THE TWISTS AND TURNS OF TORSION-DETORSION SYNDROME

Öz

In children, acute scrotal pain is a common source of urological consultation in the Emergency Department (ED). The annual incidence of acute testicular torsion is low, however, despite the small number of cases, a diagnosis of testicular torsion (TT) is very crucial as it can result in non-salvageable testes. Color Doppler Ultrasound (CDUS) is the most effective and convenient test in diagnosing TT with a high diagnostic sensitivity and specificity. Torsion-detorsion syndrome (TDS) is when the testicle undergoes repeated episodes of twisting and untwisting of the spermatic cord. In contrast to TT, the findings on CDUS in TDS may vary. The intermittent nature of the torsion episodes and the variable results on CDUS make surgical exploration a crucial step in confirming the diagnosis of TDS. In this case report, we present a patient with recurrent episodes of acute scrotal pain but negative results on CDUS. This case highlights the potential for misdiagnosis of TDS. Clinicians should be highly vigilant in cases of recurring episodes of acute scrotal pain, despite negative imaging tests. If left untreated, TDS can progress into TT whereby the testicular salvage is attainable only if intervention is undertaken within 6 hours of the onset of pain.

Anahtar Kelimeler

• Testicular torsion
• Torsion-detorsion syndrome
• Color Doppler Ultrasound
• Emergency Department

BÜKÜM KADERİ: DÖNGÜ DEĞİŞİM SENDROMUNUN DÖNGÜLERİ VE DÖNÜŞLERİ

Öz

Çocuklarda akut skrotal ağrı, Acil Servis'te (ED) ürolojik konsültasyonun yaygın bir kaynağıdır. Akut testis torsiyonu yıllık insidansı düşüktür, ancak vaka sayısının az olmasına rağmen, testis torsiyonu (TT) tanısı çok kritik öneme sahiptir; çünkü bu durum kurtarılamaz testislere yol açabilir. Renkli Doppler Ultrasonografi (CDUS), TT'nin tanısında yüksek tanı hassasiyeti ve özgüllüğü ile en etkili ve pratik testtir. Torsiyon-detorsiyon sendromu (TDS), testisin spermatic kordun döndüğü ve döndüğü tekrar eden olaylar geçirdiği durumdur. TT'nin aksine, TDS durumundaki CDUS bulguları değişiklik gösterebilir. Torsiyon olaylarının aralıklı doğası ve CDUS'daki değişken sonuçlar, TDS tanısını doğrulamak için cerrahi keşfi kritik bir adım haline getirir. Bu vaka raporunda, tekrar eden akut skrotal ağrı epizodları olan ancak CDUS'da negatif sonuçlar veren bir hastayı sunuyoruz. Bu durum, TDS'nin yanlış tanı alma potansiyelini vurgulamaktadır. Klinikçiler, negatif görüntüleme testlerine rağmen tekrarlayan akut skrotal ağrı vakalarında son derece dikkatli olmalıdır. Tedavi edilmezse, TDS TT'ye ilerleyebilir ve testis kurtarma yalnızca ağrının başladığı ilk 6 saat içinde müdahale yapılması durumunda mümkündür.

Anahtar Kelimeler

• testis tersiyeri
• torsiyon-detorsiyon sendromu
• renk doppler ultrason
• acil servis

Kaynakça

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