Differential Diagnosis

1. Testicular torsion
2. Torsion of testicular/epididymal appendage
3. Orchitis - mumps / epididymo-
4. Incarcerated hernia
5. Hydrocoele

Management

1. History
2. Examination
3. Investigations
   • Scrotal USS: can demonstrate flow of blood in testicular artery. Poor negative predictive value
4. Treatment
   • When suspected immediate exploration is indicated within 8 hours (after 8 hours, infarcted testis is unlikely to recover

Surgical Approach

1. Access scrotum
   • Skin, dartos, external spermatic fascia, cremasteric fascia, internal spermatic fascia, tunica vaginalis/albuingea, testis ("Some damn Englishman called it the testis")
2. Assess testicle for viability
   • Release torted testis
   • Wrap in warm soaked gauze for 10minutes
3. Fix other testicle
   • Explore contralateral hemiscrotum
   • Insert 3point fixation for testis to tunica vaginalis
   • Close with non-absorable sutures
4. If viable, fix; if not viable clamp, ligate and remove