Bilateral simultaneous testicular torsion presenting as a diagnostic dilemma

Abstract

Bilateral simultaneous testicular torsion is a rare condition and can be misdiagnosed. The 16-year-old patient presented with a 3 h history of left hemi-scrotal pain, nausea and vomiting. His comorbidities included DiGeorge syndrome (22q11 deletion syndrome). Patient's scrotal examination was misleading because both testes were retracted. His cremasteric reflex was negative bilaterally. Scrotal ultrasound findings were consistent with the diagnosis of the left testicular torsion. An examination under anaesthesia revealed high riding and oblique position of the left testicle, but the position of the right testicle was unremarkable. The patient underwent an emergency left hemiscrotal exploration and untwisting of the left testicle. The right hemi-scrotal exploration revealed a 540° clock-wise right testicular torsion. The case demonstrates the importance of bilateral hemi-scrotal exploration in a patient presenting with acute testicular pain due to a testicular torsion. Bilateral scrotal exploration is mandatory not only for diagnostic but also for treatment purposes.