[Torsion of the spermatic cord after prophylactic orchidopexy]

Torsion of the spermatic cord is a urological emergency. The torsion of a fixed testis is rare. In the differential diagnosis of acute scrotum it remains a true challenge.

A 13-year-old boy presented in the emergency service with acute left testicular pain and vomiting. In the patient's history a right orchiectomy due to testicular torsion and a left prophylactic orchidopexy were remarkable. Due to the clinical suspicion of re-torsion an immediate surgical exposure of the testis was performed. Intraoperatively a torsion of the left spermatic cord was found. After detorquation, there was no significant sign of recovery observed. In order to preserve the endocrine function, the single testis was maintained. During follow-up, necrosis of the left testis was noticed, and a secondary left orchiectomy was necessary three weeks after first operation. After loss of both testes the patient was referred to a paediatric endocrinological consultant and testosterone substitution was started.

Even though very rare, orchidopexy does not exclude re-torsion of a fixed testis, regardless of the employed operative technique and sutures used. It should be considered in the differential diagnosis of acute scrotum. Operative detorquation should not be delayed and, in order to avoid loss of the affected testis, diagnostic procedures should kept short. After orchidopexy the patient and his relatives must be informed about the possibility of a re-torsion.