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Purple-black necrotic ‘tomato seed’ must be removed after a dull pain

3 days ago, the young man felt mild pain in the right testicle, no fever. Hesitating, the next day he went to a clinic near his house and then returned to take medicine. On the 3rd day of hospitalization, his ‘tomato seeds’ were purple, black and necrotic.

On May 28, the Emergency and Intensive Care Unit of Hanoi Medical University Hospital said that this unit had recently admitted two young men under 20 years old to the hospital because of testicular pain.

Both had a perfectly healthy history, diagnosed with testicular torsion, but in two different situations, the direction of intervention and the outcome were also different.

The first case is a 19-year-old male, admitted to the hospital because of pain in the right scrotum, day 3. The young man has a healthy history. Three days before admission, his right testicle had mild dull pain, no fever, and no urinary disturbances.

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Testicular torsion is common in pubertal males.

After 1 day, he went to a private clinic, was diagnosed with orchitis, and gave a prescription to take home. However, the patient did not feel better, so he went to the Hanoi Medical University Hospital for examination.

On examination, the doctor noticed that his right testicle was large in size, painfully pressing. The patient was assigned testicular ultrasound with doppler, the results showed that the testis and epididymis must have diffuse hypoechoic, loss of pulse signal on the doppler.

The patient was diagnosed with testicular torsion on day 3, indicated for emergency surgery. However, when dissected, the right testicle had purple-black necrosis due to torsion in the seminal vesicles twice. The surgeon had to remove the patient’s right testicle.

The second case is an 18-year-old male. He said he was sleeping in the middle of the night when he suddenly felt a sharp pain in the right scrotum. He immediately went to the hospital right away, in the second hour after the pain.

Testicular ultrasound with doppler pulse was also performed as in case 1, the results showed that the right testicle was enlarged, misaligned, and decreased perfusion on the doppler, however, the testicular parenchyma was only mildly hypoechoic and heterogeneous.

With the diagnosis of testicular torsion in the second hour, the patient was immediately pushed straight into the operating room for intervention, as fast as a stroke emergency or multi-trauma emergency. After untwisting, the testicle was warm again and the patient kept the right testicle.

Doctors said, testicular torsion is the twisting of the spermatic cord (testicular stalk) including blood vessels that feed the testicle, leading to ischemia and necrosis of the testicle.

The disease is common around puberty (accounting for more than 60%) with symptoms usually a sudden sharp pain in one testicle. However, in many cases, patients only have mild testicular pain like orchitis, so it is easy to misdiagnose. For emergency physicians or male urologists, testicular torsion is a medical emergency such as stroke or multi-traumatic shock. If the torsion is not rapidly released within the first 6 hours, the patient is at high risk of orchiectomy.

Men who see signs of pain in the scrotum on one side should quickly go to the hospital for a timely and accurate examination and diagnosis. In fact, the ability to “save” the testicles is quite high for patients who arrive before 6 hours, up to 90-100%. The rate of successful testicular preservation falls below 50% if the patient arrives after 12 hours and especially less than 10% if the patient arrives after 24 hours.

Thanh Hien

hat ca hoai tu tim den phai cat bo sau con dau am i 985bd9529621458aad446091c049307d

14-year-old boy suffered testicular torsion, almost secondary infertility

hat ca hoai tu tim den phai cat bo sau con dau am i 674d0afa509e4dbb84023ccb0c211602A male male student wakes up one night with severe pain in the scrotum, the pain increases when touched, the left testicle is located higher than normal and less mobile than the right testicle.

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