Inguinal Hernia Resulting in Testicular Ischemia

2018 ◽  
Vol 1 ◽  
pp. 3 ◽  
Author(s):  
Komal Chughtai ◽  
Jeffrey Kallas ◽  
Vikram S. Dogra
Keyword(s):  
Blood Flow ◽  
Inguinal Hernia ◽  
Testicular Torsion ◽  
Unusual Case ◽  
Color Flow ◽  
Scrotal Pain ◽  
Ultrasound Evaluation ◽  
Testicular Blood Flow ◽  
Testicular Ischemia ◽  
The Right

The absence of blood flow in the testicle is classically thought to be secondary to testicular torsion; however, other etiologies of compromised testicular blood flow have been described. We present an unusual case of testicular ischemia secondary to an inguinal hernia. A 58-year-old male presented to the emergency department with right-sided scrotal pain and swelling. Color-flow Doppler ultrasound evaluation demonstrated lack of blood flow in the right testicle and a right-sided inguinal hernia. The testicular blood flow was re-established with reduction of an inguinal hernia.

scholarly journals The Diagnostic Accuracy of Testicular Torsion by Doctors on Duty Using Sonographic Evaluation with Color Doppler

2020 ◽  
Vol 14 (5) ◽  
pp. 155798832095300
Author(s):  
Akinori Nakayama ◽  
Hisamitsu Ide ◽  
Akiyoshi Osaka ◽  
Yasuyuki Inoue ◽  
Yukihito Shimomura ◽  
...  
Keyword(s):  
Blood Flow ◽  
Diagnostic Accuracy ◽  
Testicular Torsion ◽  
Color Doppler ◽  
Ultrasonic Transducer ◽  
Color Doppler Ultrasound ◽  
Medical Emergency ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Testicular Blood Flow

As testicular torsion is a medical emergency, it requires quick diagnosis and treatment. Color Doppler ultrasound (CDUS) is useful for the diagnosis of testicular torsion. An accurate diagnosis can be difficult when CDUS indicates the preservation of blood flow in the testis. We examined the accuracy of testicular torsion diagnosis in patients with acute scrotum made by doctors on duty using CDUS. The subjects included 26 patients who visited our department between January 2016 and June 2018 presenting with acute scrotal pain. Patients were placed into one of three groups based on testicular blood flow evaluated by CDUS. The first group had no testicular blood flow, the second had diminished blood flow, and the last group had normal or increased blood flow. Patients were also diagnosed through scrotal exploration. Finally, patients were further divided into two groups identified by CDUS frequency utilized during diagnosis (12 MHz groups and ≤8 MHz groups), and the diagnostic accuracy of the two groups was compared. Characterizing torsion by either the absence of or diminished, testicular blood flow in the CDUS evaluation, the sensitivity and specificity of the CDUS performed by doctors on duty accounted for 69.2% and 53.8%, respectively. No improvement in diagnostic accuracy was evident despite the usage of a 12-MHz ultrasonic transducer. In this study, the sensitivity of CDUS performed by doctors on duty was about 70%, suggesting that scrotal exploration should be performed promptly even if testicular blood flow is observed and testicular torsion is suspected from medical history and body findings.

Approach to Male Urologic Emergencies

2019 ◽  
Author(s):  
Jonathan E. Davis ◽  
Jeffrey S. Dubin
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
Necrotizing Fasciitis ◽  
Testicular Torsion ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Penile Pain ◽  
Emergency Department Setting ◽  
Acute Scrotal Pain

This review details the evaluation and management of the acute scrotum in the emergency department setting and emergent penile complaints in adults, with an emphasis on the most serious and most common conditions. Other emergent conditions include necrotizing fasciitis of the perineum (Fournier disease), incarcerated or strangulated inguinal hernia, and genitourinary (GU) trauma. Emergency practitioners need to be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis. Basic anatomy and bedside evaluation are reviewed. Acute scrotal and penile pain and GU trauma are discussed in terms of assessment and stabilization, diagnosis, and treatment and disposition.  This review contains 5 figures, 19 tables, and 71 references. Keywords: Acute scrotal pain, testicular torsion, priapism, Peyronie disease, paraphimosis, phimosis, balanitis, posthitis, epididymitis

Sonographic appearances of the epididymis in boys with acute testicular torsion but preserved testicular blood flow on color Doppler

2015 ◽  
Vol 45 (11) ◽  
pp. 1661-1671 ◽  
Author(s):  
Paraskevi Galina ◽  
Vasiliki Dermentzoglou ◽  
Nikolaos Baltogiannis ◽  
Maria Zarifi
Keyword(s):  
Blood Flow ◽  
Testicular Torsion ◽  
Color Doppler ◽  
Testicular Blood Flow

Decreased Blood Flow in the Testis: Is it Testicular Torsion?

2018 ◽  
Vol 1 ◽  
pp. 13 ◽  
Author(s):  
Allison Forrest ◽  
Akshaar Brahmbhatt ◽  
Vikram Dogra
Keyword(s):  
Blood Flow ◽  
Testicular Torsion ◽  
Imaging Finding ◽  
Color Flow ◽  
Diastolic Flow ◽  
Asymptomatic Patients ◽  
Doppler Waveform ◽  
Pictorial Essay ◽  
Spectral Doppler ◽  
Similar Appearance

The absence of blood flow in the testis on ultrasound examination is the gold standard for diagnosis of testicular torsion. This imaging finding is seen in the vast majority of patients with testicular torsion, except in patients with partial torsion. Patients with partial testicular torsion may have reversal of arterial diastolic flow on spectral Doppler, decreased amplitude of the spectral Doppler waveform (parvus tardus wave), or monophasic waveforms. However, it is important to consider that not all absence of blood flow or reversal of diastolic flow in testis represents testicular torsion, as other conditions may have a similar appearance, including rare detection of such a pattern in normal asymptomatic patients. Conditions that commonly mimic testicular torsion include incarcerated inguinal hernias and complications following hernia repair,thrombotic phenomena, vasculitis, complicated epididymo-orchitis, asymptomatic variants, and technical limitations of ultrasonography. It is important for a practicing radiologist to be familiar with such cases to avoid unnecessary surgical interventions.We present a pictorial essay of cases in which the absence of testicular blood flow on color flow Doppler or abnormal waveforms on spectral Doppler are identified, without the presence of testicular torsion.

scholarly journals LO014: What ultrasonography characteristics predict surgical intervention for testicular torsion in adults?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S35-S35
Author(s):  
B.W. Ritcey ◽  
M. Woo ◽  
M.D. McInnes ◽  
J. Watterson ◽  
J.J. Perry
Keyword(s):  
Blood Flow ◽  
Testicular Torsion ◽  
Surgical Intervention ◽  
Emergency Department Visits ◽  
Point Of Care Ultrasound ◽  
Colour Doppler ◽  
Scrotal Pain ◽  
Test Characteristics ◽  
Ultrasound Findings ◽  
Pulsed Wave Doppler

Introduction: Testicular torsion is a time sensitive condition for which there can be significant delays to surgery or transfer to definitive care while trying to obtain an ultrasound to confirm the diagnosis. This study determines the test characteristics for each individual sonographic sign of testicular torsion associated with the patient requiring surgical intervention. Methods: A retrospective health records review of adult patients with acute, non-traumatic scrotal pain or swelling (defined as under 24 hours since onset) presenting to one of two Canadian academic tertiary care emergency departments between November 2009 and March 2013 was performed. A single data abstractor completed a case report form for each patient including demographics, individual ultrasound findings, final diagnosis, and need for surgical intervention. The sensitivity and specificity of each ultrasonographic sign (including testicular heterogeneity, decreased colour doppler, and decreased pulsed wave doppler) at predicting surgical intervention during the same hospital visit was calculated along with 95% confidence intervals. Results: During the study period there were a total of 876 emergency department visits for scrotal pain, of which 198 patients met our inclusion criteria. The included patients had a mean age of 36.2 years. Decreased blood flow to the painful testicle on colour doppler showed the best overall test characteristics with a sensitivity of 82.4% (95% CI 55.8%-95.3%) and specificity of 100% (95% CI 96.3%-100%) for predicting a need for surgical intervention for testicular torsion. Other ultrasound findings for testicular torsion included a heterogeneous appearance of the painful testicle (sensitivity 47.1% [95% CI 23.9%-71.5%], specificity 77.4% [95% CI 68.9%-84.2%]), and decreased arterial or venous flow on pulsed wave doppler (sensitivity 76.5% [95% CI 49.8%-92.1%], specificity 100% [95% CI 96.3%-100%]). Conclusion: Decreased blood flow to the painful testicle on colour doppler showed excellent specificity and can rapidly “rule-in” a need for surgical intervention for testicular torsion. Given that colour doppler is relatively easy to learn and perform, future studies should assess the use of colour doppler using point of care ultrasound to expedite surgical consultation.

Antisperm antibodies and testicular blood flow after inguinal hernia mesh repair

2014 ◽  
Vol 28 (12) ◽  
pp. 3413-3420 ◽  
Author(s):  
Ivana Štula ◽  
Nikica Družijanić ◽  
Ada Sapunar ◽  
Zdravko Perko ◽  
Nada Bošnjak ◽  
...  
Keyword(s):  
Blood Flow ◽  
Inguinal Hernia ◽  
Mesh Repair ◽  
Antisperm Antibodies ◽  
Hernia Mesh ◽  
Testicular Blood Flow ◽  
Hernia Mesh Repair
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