1. Patient details Atul 13 yr old boy studying in 6 th class,came with history of sudden pain in right groin since 10 pm, the night before.Vomiting two times.

2. OE; boy was having tachycardia, Abdomen showed tenderness in the RIF,hypogastrium. External genital showed right side of scrotum enlarged in size and was tense and tender to palpate. What is provisional working diagnosis?

3. Torsion of the right sided testis.

4. Twisting or torsion of the testis can produce occlusion of testicular blood flow-gonadal necrosis. Necrosis starts in as little as 2hr and is complete by 24hrs of ischemia. Loss of spermatogenesis occurs after 6hrs of torsion. Loss of Lehdig cells occurs after 10 hrs of torsion.

5. Torsion is of two types-Extravaginal and intravaginal. Extravaginal is less common confined to infants-during testicular descent it is loosely adherent to surrounding structures leading to torsion. Intravaginal is the most common variety.

6. Intravaginal- predisposed by a high investment of the spermatic cord by tunica vaginalis. Testis is pendulous and tend to lie horizontally within(clapper in the bell). Inversion of testis. Separation of epididymis. Strain. Spontaneous at sleep.

7. Incidence is highest in infancy and adolescence-peak incidence 13 to 16 yrs. Patient c/o sudden onset of pain in the scrotum, groin,or lower part of the abdomen. Pain may be associated with nausea and vomiting. Scrotum is extremely tender to palpate, it becomes rapidly edematous& erythematous.

8. Overtime testis infarcts-scrotum takes bluish discoloration. Differential diagnosis- 1)Mumps orchitis. 2) Epididymoorchitis. 3) Twisted appendix of testis. 4)small strangulated hernia

9. Early diagnosis is cornerstone in the management of testicular torsion. Progressive ischemia-necrosis mandates urgent clinical decision making. Doppler study and radioisotope scan. Time constraints imposed by progressive testicular ischemia, diagnostic delay and clinical indecision should not inhibit prompt surgical intervention.

10. Treatment –immediate scrotal exploration on the involved side. Untwist the twisted testis-wait forseveral minutes-intraoperative doppler is also used. Viable –fix the testis within the tunica with non absorbable sutures, nonviable- ochiedectomy. Other side testis should also be fixed,because defect is often bilateral.

13. Thank you