Aireen ZAMHOT, Chau Yi Wen EVELYN, Chun Chau TAN
Journal of Emergency Medicine Case Reports - 2026;17(1):9-13
In children, acute scrotal pain is a common source of urological consultation in the Emergency Department (ED). The annual incidence of acute testicular torsion is low; however, missing the diagnosis has catastrophic outcomes. Color Doppler Ultrasound (CDUS) is the most effective and convenient test for diagnosing TT, with high diagnostic sensitivity and specificity. Torsion-detorsion syndrome (TDS) occurs when the testicle undergoes repeated episodes of twisting and untwisting of the spermatic cord. Unlike TT, imaging can look normal and may not be reliable for detecting, especially when the testis is detorsed at the time of scanning, which makes diagnosis challenging. The spontaneous untwisting of the spermatic cord makes surgical exploration a crucial step in confirming the diagnosis of TDS. This case report describes a patient with recurrent acute scrotal pain and normal CDUS findings, yet significant pathology was identified on surgical exploration, underscoring the risk of misdiagnosing torsion-detorsion syndrome (TDS). Clinicians should be highly vigilant in cases of recurring episodes of acute scrotal pain, despite negative imaging tests. If left untreated, TDS can progress into TT, whereby the testicular salvage is attainable only if intervention is undertaken within 6 hours of the onset of pain.
