Bilateral synchronous intravaginal testicular torsion presenting with unilateral testicular pain

An adolescent presented with a 5 hour of history of unilateral testicular pain and examination findings in keeping with a unilateral testicular torsion. On scrotal exploration, there was evidence of bilateral testicular torsion and bilateral orchidopexy was subsequently performed. Intravaginal bilateral testicular torsion is scarcely reported in adolescents and adults. Both unilateral and bilateral testicular torsions in adolescents are commonly associated with anatomical anomalies, which were not evident in this case. Despite warming the symptomatic testis for 40 minutes, viability was indeterminate. Guidelines remain equivocal about adequate reperfusion period before considering orchiectomy. Interval sonographic follow-up is recommended to assess testicular atrophy; however, considerable variation exists in practice. This is an atypical case of bilateral synchronous testicular torsion demonstrable by an absence of classical risk-factors, alongside unilateral clinical signs and symptoms. Inconsistency in guidelines for attempted reperfusion could result in orchiectomy where testicular salvage is possible.