Neonatal testicular torsion may be relatively painless and presents as a firm discoloured scrotal swelling which does not transilluminate. Intravaginal testicular torsion causes acute scrotal pain which may be associated with lower abdominal pain, nausea and vomiting. The left testis is twice as commonly involved as the right. There may be a history of similar, milder complaint, suggesting previous twisting and untwisting of the testis. The testis is tender, swollen and often elevated. The contralateral testis may have a transverse lie.

Testicular torsion is an emergency as delay in diagnosis and treatment will result in testicular infarction: necrosis occurs within 6 h of the onset of symptoms and few testes will survive >24h of torsion. The commonest differential diagnoses are torsion of testicular appendages and epididymo-orchitis (see above). Doppler ultrasound and radioisotope scan demonstrating reduced testicular blood flow in testicu-lar torsion have been advocated for use in doubtful cases but these should only be attempted if the expertise is available and the tests can be performed without delay. Prompt scrotal

exploration is the safest approach for any child with the slightest doubt in testicular torsion.

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