In this type of torsion, the spermatic cord twists inside the tunica vaginalis. This is thought to occur because of an abnormal attachment of the spermatic cord to the testis, which allows the testis to turn easily within the scrotum. This anatomic relationship, in which the testicle has a transverse lie, is termed the bell-clapper deformity (Fig. 12.3). This horizontal lie is a risk factor for torsion. Generally, intravaginal torsion occurs in children as well as adults, but usually in adolescents.

Bell Clapper Deformity
12.1. Physical examination of extravaginal torsion. Note the lie of the affected testicle
Extravaginal Torsion
12.2. Intraoperative photograph of extravaginal testicular torsion
Scrotal Torsion
12.3. Intraoperative photograph of intravaginal torsion

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