Testicular torsion in older men: It must always be considered

Scrotal pain is a common presenting symptom among patients referred to emergency room. True urological emergency, such as testicular torsion, must be considered. Testicular torsion is exceedingly rare in the geriatric population, in whom infectious or even malignant etiologies are more common. There are reports of men in the sixth and seventh decades of life with torsion. The testicular salvage rate in adults with torsion is poor,1 because of the lack of recognition of this entity by physicians. We present the case of a 66-year-old man who presented to the emergency department with scrotal Pain and was eventually found to have testicular torsion after scrotal imaging and surgical exploration. This case highlights the need to consider torsion in the differential diagnosis of any man presenting with scrotal pain, regardless of his age. Case report A 66-year-old man presented to the emergency department with a 6-h history of right-sided scrotal pain and swelling. The pain had begun abruptly while doing cycling and was constant and severe. It was not associated with trauma, fever, or irritative voiding symptoms. He was given a diagnosis of epididymo-orchitis by the emergency department staff and discharged home with a course of ofloxacin. The patient was referred to urology department. He was seen for follow-up one week later, he had had only moderate improvement of his pain and no improvement of the scrotal swelling. Examination revealed enlarged, erythematous right hemiscrotum with induration extending to the external inguinal ring. The left scrotum and testicle were normal on examination. He described a history of intermittent scrotal pain spontaneously resolving of the right testis. Because of the lack of improvement, a scrotal ultrasound was ordered. The ultrasound showed an absence of blood flow to the right testicle with normal flow on the left side (Fig. 1). Open in a separate window Fig. 1 Doppler ultrasound demonstrating absent vascular flow in the right testis.