Presentation is typically with an acutely swollen and painful testis, lower abdominal pain and sometimes, vomiting. The abdominal pain occurs because the testis retains its embryological nerves supply which primarily, is from the T10 sympathetic pathway.
There may be a history of mild trauma to the testis or of previous episodes of testicular pain due to torsion and untwisting.
The testis lies horizontally, high in the neck of the scrotum. In the early stages, the cord may be palpably thickened. Later, palpation is difficult as the overlying scrotal skin becomes red and oedematous.
Pain is not relieved by elevating the twisted testis - negative Prehn's sign. The cremasteric reflex is absent.
A neonatal torsion may be without symptoms and simply present as a hard, enlarged testes in a blue scrotum. They tend to present late, and it is more difficult to preserve the testes.
Of boys presenting with acute scrotal swelling only 25% will have torsion of the testis.
Last reviewed 02/2020