Testicular torsion – an important consideration in neonatal scrotal swelling

Scrotal swelling in a neonate is rarely caused by testicular torsion, but it is an important differential diagnosis as acute treatment can prevent loss of fertility. The clinical findings differ, depending on whether the torsion has occurred in utero (prenatal) or after birth (postnatal). Postnatal testicular torsion presents with pain, redness, and swelling of the affected testis and requires acute surgical intervention to restore the blood flow and prevent ischemic necrosis. Contrary, prenatal testicular torsion will present with a hard, discolored untender mass that has already atrophied. It is important to quickly distinguish between prenatal versus postnatal cases to enable timely surgery of postnatal torsion, whereas the treatment of prenatal torsion is less urgent. A thorough clinical examination and ultrasonography with Doppler to detect blood flow or the lack of flow are the cornerstones in establishing an early diagnosis.