Testicular torsion, a critical urological emergency, poses the risk of testicular loss, emerging as the most signicant acute scrotal condition. The bell clapper deformity, characterized by inadequate testicular attachment to the tunica vaginalis, augments testicular mobility, creating a predisposition to torsion. The resulting twisting of the spermatic cord leads to venous compression, edema, and eventual ischemia due to arterial occlusion. Neonatal torsion follows an extravaginal pattern, with two peak incidences, notably during puberty. Clinically, patients experience sudden, intense testicular or scrotal pain, often accompanied by nausea and vomiting. Diagnosis primarily relies on clinical ndings, supported by the TWIST score, and, in equivocal cases, scrotal Doppler ultrasound. Management entails immediate urological consultation, with surgical interventions such as detorsion and orchiopexy for viable torsion or orchiectomy for nonviable cases. Manual detorsion before surgery can salvage the testicle, and the debate over the necessity of bilateral orchiopexy persists. Appendiceal torsion, common in boys aged 7 to 12, is clinically diagnosed, managed with analgesia and scrotal support, with surgery (appendage removal) considered for persistent pain. Intermittent testicular torsion presents as acute, sharp pain with rapid self-resolution, recurring intermittently in boys. In a review, 26 percent experienced nausea or vomiting, and 21 percent reported nocturnal pain. Physical signs include mobile testes, anterior epididymis, or a bulky spermatic cord. Clinical and radiographic evaluations may be normal, emphasizing the need for follow-up on recurrent or worsening pain. Ultrasound, while up to 75 percent sensitive, often shows normal ndings, underscoring the diagnosis's clinical nature. Immediate follow-up is crucial, and a seven-day reassessment is recommended if initial evaluations are unremarkable. Awareness of intermittent torsion aids timely intervention, preventing complications and ensuring optimal care for affected individuals.
