Torsion of testis – Torsion of Morgani cyst

GENERAL
The man's testicles live inside the scrotum (the pouch containing the testes) and hang from a "package" of elements that descend from the abdomen through the inguinal canal to the scrotum. This "package" is called spermatic tone and contains:
 

  1. The spermatic artery that supplies the testicle with arterial blood
  2. The spermatic vein through which the return to the heart of the venous blood
  3. The vas deferens, thin channel "upload" from the testis and epididymis the spermatozoids and results in two small bags that are low below the bladder, the seminal lykithous. The vas deferens travels parallel to his own artery, the artery of the vas deferens, which help with the main spermatic artery perfusion of the testis and epididymis.
  4. An elongated pending muscle that creates transient movements of the testicles upwards (elevation of the testicles).

 

HOW IS THE TWIST - SYMPTOMS

If the testicle is doing a turn around itself from the 180 degress and up, the arteries that supply it "bent" so the blood flow is interrupted and the testicle is in ischemia from one moment to another.
To understand how this happens, imagine the hose watering of your balcony which in the slightest "kink" - "wrap" stops running water.
When the testis in ischemia, the symptoms are acute and immediate. The child feels strong pain suddenly, begins to cry if you are young and scrotum is expanding (swelling) and becomes red.
The sudden ischemia may even within 3-4 hours to create permanent testicular necrosis. The twisting of the testis is one of the most urgent surgical situations. The child should be operated upon as soon as possible to restore blood flow to the testis and achieve his vitality.

Fortunately we have seen testicles to survive by interventions which were even 10 hours after symptom onset. This is due to kinking of the artery is sometimes partial, leaving the passage of a small amount of blood.
If there is no nearby surgical center for children, can be done by a doctor detorsion of the testis over the skin of the scrotum. Unfortunately, the hands external detorsion is not always successfull.

 

THE SURGERY
The surgery is performed under general anesthesia through a small incision on the scrotum. …………… testis, which very often is black (ischemia) and wait to see if he regains a normal morphology.
If you do not gain normal morphology, the testis is removed with the same surgical session. The other good testicle is secured with stiches, through a second controlateral scrotal incision to prevent a future torsion.

 

AGE OF TORSION
The twisting can be done at any age and up to the age of 20-25 years.
The twisting can be done during fetal life before birth. In this case newborn already has a very small atrophic nonfunctional testicle.

 

TORSION OF MORGANI CYST
 The Morgani cyst (name of the scientist who described it as anatomical entity) is a small outgrowth (horns) that sprouts from the upper pole of the testis border union with the head of the epididymis. Corresponds to the residue through female genital mutilation.
The embryo at the beginning of his life has elements which will be developed later, depending on the chromosomes, male or female internal and external genitalia. In the male and the female understeer and remains in place, the Morgani cyst, which has no functionality.
The "horns" can twist around its axis, to ischaimia and create the same symptoms with the torsion of the testis, but more gently. And swelling and redness and pain is less intense than in the torsion of testis.
An experienced surgeon with the clinical examination can distinguish the difference between the two conditions in most situations. When we are confident that is only torsion of  Morgani cyst, there is no indication for surgical intervention. Pain and swelling hold approximately 24 hours and then subside. More rarely the pain lasts longer and the doctor is forced to intervene as to aboid inflammation of the testis and epididymitis.
In diagnosis, when possible, can help an ultrasound-doppler imaging in addition to skills and studying the flow of blood in arteries and seminal testis.

 

Torsion of the left testis in a few months old baby

Swelling and redness of the left testis



 

Pediatric Urology
and Endocrine Clinics

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