{"id":26569,"date":"2026-02-02T14:23:28","date_gmt":"2026-02-02T14:23:28","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=26569"},"modified":"2026-02-03T08:21:22","modified_gmt":"2026-02-03T08:21:22","slug":"testicular-torsion","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/testicular-torsion\/","title":{"rendered":"Testicular Torsion"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p>Testicular torsion occurs when there is twisting of the testicle on the spermatic cord leading to disruption of the vascular supply. If left untreated, this can cause ischaemia and death of the testicle. Predisposing factors include a \u2018bell clapper\u2019 deformity where the testicle is more mobile and therefore at higher risk of twisting, and trauma in a minority of cases.<\/p>\n\n\n\n<p><strong>Clinical Features and Epidemiology:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Age: commonly affects pubertal boys.<\/li>\n\n\n\n<li>Acute Onset of Pain: severe, unilateral scrotal pain that occurs suddenly and is constant.<\/li>\n\n\n\n<li>Associated Symptoms: nausea, vomiting, lower abdominal pain.<\/li>\n\n\n\n<li>Physical Exam: affected testicle may appear swollen and red. The testicle may be elevated compared to other side (high riding) and have an absent cremasteric reflex (no lifting of the testicle when stroking the upper inner thigh). Pain is severe across whole testicle on palpation.<\/li>\n\n\n\n<li><strong>Time is critical \u2013 surgery should ideally occur within 4 hours of onset<\/strong>.<\/li>\n<\/ul>\n\n\n\n<p><strong>Differentials:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Torsion of the testicular appendage aka hydatid: less severe pain at rest but is still very tender on palpation. Otherwise well, often no associated symptoms. Characteristic \u2018blue dot\u2019 on examination (subtle dark blue hue seen through scrotum, most noticeable in pale skin tones). Pain is worse in upper pole of testicle. Commonly affecting pre pubertal boys.<\/li>\n\n\n\n<li>Epididymitis: pain develops gradually over hours to days. Often associated with urinary symptoms such as painful urination or discharge. On palpation pain is worse over epididymis rather than testicle.<\/li>\n\n\n\n<li>Inguinal hernia: unilateral swelling of the scrotum that is full. Should be soft and reducible. If firm and very painful <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/incarcerated-hernia\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/incarcerated-hernia\/\" target=\"_blank\" rel=\"noreferrer noopener\">see page on Incarcerated Hernia.<\/a><\/li>\n\n\n\n<li>Hydrocele: painless swelling of the testicle. Will transilluminate on examination. Often associated with viral illness in younger children and will self-resolve. Can feel above lump. <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatricsurgery\/scrotal-hydrocele\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatricsurgery\/scrotal-hydrocele\/\" target=\"_blank\" rel=\"noreferrer noopener\">See page on Scrotal Hydrocele.<\/a><\/li>\n<\/ul>\n\n\n\n<p><strong>G.O. &amp; D.M. &#8211; 3\/2\/26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Any child who has the above clinical features.<\/li>\n\n\n\n<li>Any child where the clinician has uncertainty or concern over symptoms.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>NHS Lothian<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bleep the on call paediatric surgery FY via RHCYP switchboard and send the child to RHCYP A&amp;E. Clinical details can be discussed over the phone.<\/li>\n\n\n\n<li>For urgent advice call the on call paediatric surgery registrar via RHCYP switchboard.<\/li>\n\n\n\n<li>Please ask patients to remain fasted until they are assessed at hospital.<\/li>\n<\/ul>\n\n\n\n<p>NHS Fife, Tayside, and Borders:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please send to local ED and they will refer on if appropriate.<\/li>\n<\/ul>\n\n\n\n<p>Advice to parents: <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>What to expect when arriving at the hospital \u2013 re-examination +\/- urgent procedure if torsion is suspected.<\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Testicular torsion occurs when there is twisting of the testicle on the spermatic cord leading to disruption of the vascular supply. If left untreated, this can cause ischaemia and death of the testicle. Predisposing factors include a &lsquo;bell clapper&rsquo; deformity where the testicle is more mobile and therefore at higher risk of twisting, and<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[],"class_list":["post-26569","page","type-page","status-publish","hentry"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":false,"rttpg_excerpt":"Information Testicular torsion occurs when there is twisting of the testicle on the spermatic cord leading to disruption of the vascular supply. If left untreated, this can cause ischaemia and death of the testicle. Predisposing factors include a &lsquo;bell clapper&rsquo; deformity where the testicle is more mobile and therefore at higher risk of twisting, and","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26569","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=26569"}],"version-history":[{"count":4,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26569\/revisions"}],"predecessor-version":[{"id":26603,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26569\/revisions\/26603"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=26569"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=26569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}