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Highlights • A rare case of bilateral epididymo-orchitis complicated with bilateral testicular infarction. • Presentation was fever with persistent, unresolved pain and scrotal swelling. • Antibiotic therapy failed to halt disease progression of bilateral testicular ischemia. • Bilateral orchidectomy performed as both testes were not viable, resulting in castration and lifelong testosterone replacement., Introduction Testicular infarction as a result of severe epididymo-orchitis is an uncommon urological emergency, with only a handful of reported cases in literature. We report an even rarer case of bilateral epididymo-orchitis complicated with testicular infarction, resulting in bilateral orchidectomy. Presentation of case 49 year old gentleman presented with fever, persistent, unresolving pain and scrotal swelling of two weeks duration. Despite close clinical monitoring, timely ultrasounds of the testis and antibiotics there was an inexorable progression to bilateral testicular ischemia. Discussion This is only the second reported case of this nature in published literature. Epididymo-orchitis usually responds well to appropriate antibiotic therapy, although progression to testicular infarction is possible. Conclusion Clinical presentation of persistent scrotal pain and oedema in cases of epididymo-orchitis should raise strong suspicion of testicular ischemia or infarction. Despite all efforts, progression to bilateral testicular infarction resulting in castration is a possible catastrophic outcome.

Segmental testicular infarction is a rare diagnosis and there are few documented cases in the literature. Those cases that have been reported are usually in the setting of epididymitis, hypercoaguable states, vasculitis, sickle cell disease, post orchidopexy or vasectomy, and idiopathic. We report a case of a patient who developed segmental testicular infarction that was managed conservatively, following nephrectomy for a ruptured kidney and the associated ultrasonographic appearances. Keywords: Segmental, Testes, Infarction, Nephrectomy, Trauma

Epididymo-testicular infarction associated with ischemia of spermatic cord without torsion secondary to an orchiepididymitis is an extremely rare pathological entity, of little known etiopathogenesis and idiopathic in the majority of cases. The authors report an original observation of a 23-year-old young patient with a history of untreated orchiepididymitis, which presented to the emergency department for testicular pain. The ultrasound has showed an ischemic testicle and the exploratory scrototomy objectified an epididymo-testicular necrosis associated with ischemia of spermatic cord without torsion. This case highlighted the interest of early diagnosis and effective treatment of orchiepididymitis to prevent this rare serious complication.

Acute testicular infarction requiring emergent surgical intervention is often the result of spermatic cord torsion; infrequently, infarction results from other etiologies. We report a case of epididymo-orchitis complicated by abscess resulting in testicular ischemia, not detected on ultrasonography. A high clinical suspicion of testicular ischemia should be maintained in any presentation of testicular pain and swelling, as recognition could lead to early salvage interventions.

The leading cause of scrotal pain in the geriatric population is epididymitis. Testicular torsion is rare in adult men. This case report of an 82-year old man with acute scrotum represents the second oldest patient reported in published studies. Due to the long delay between the onset of clinical symptoms and surgical exploration, the testicular infarction with necrosis and orchiectomy ultimately occurred. The diagnosis of testicular torsion in the geriatric population is often delayed and lacks awareness for the diagnosis.

Introduction and importance Acute scrotum is considered a urological emergency requiring early intervention depending on the cause. There are multiple causes of acute scrotum with testicular torsion being the most feared as delayed treatment leads to testicular loss. However, differentiating between epididymo-orchitis and torsion can be very difficult. Case presentation We present a case of an 18-year old male patient with 2 separate episodes of acute scrotum. He had epididymo-orchitis as the first presentation followed by testicular torsion 5 days later. To our knowledge this is the first case of testicular torsion secondary to epididymo-orchitis. Clinical discussion Differentiating between epididymo-orchitis and torsion is challenging but important due to risk of loss of testis with a wrong diagnosis. Once you establish epididymo-orchitis the suspicion for subsequent torsion should be high with close follow up and adequate counselling. Conclusion He ultimately had orchiectomy, although a rare presentation, enlarged testis due to epididymo-orchitis can predispose an individual to developing testicular torsion thus adequate counselling on warning signs to patients with epididymo-orchitis is of particular importance so as to intervene early and ultimately save the testis., Highlights • 18-year old male presenting with 2 separate episodes of acute scrotum. • Initially diagnosed to have epididymo-orchitis with confirmation of color doppler ultrasound • Second acute scrotum 5 days after and diagnosed to have torsion • Unsalvageable testis due to delay in second presentation • Epididymo-orchitis as a preceding risk factor to develop torsion

Testicular infarction is a common urological emergency in clinical practice, it is still underreported when it results from other than spermatic cord torsion. It rarely arises from other pathological processes like vasculitis and infectious disease. We report a case of 18-year-old with epididymo-orchitis complicated by testicular ischemia. This case accentuates the need for a high index of suspicion to rule out concomitant testicular ischemia secondary to epididymo-orchitis that might be salvaged in the future with immediate surgical intervention. Testicular infarction is a devastating complication from epididymo-orchitis that is difficult to predict and distinguish from more common presentations of acute scrotum. Keywords: Testicular infarction, Ischemia, Epididymitis, Epididymo-orchitis

Background Testicular infarction is a known serious complication associated with epididymitis. It is known to be idiopathic in 70% of cases but the frequency, risk factors, and management are yet to be elucidated. This paper aims to report a case of testicular infarction secondary to pyogenic epididymoorchitis caused by Pseudomonas aeruginosa. Case presentation A 64-year-old male with a past medical history of benign prostate hypertrophy using intermittent self-catheterization and a recent history of culture-negative pyogenic epididymoorchitis treated with oral cefpodoxime was admitted to our hospital due to a 4-week history of fever, right scrotal pain, and swelling. Scrotal ultrasonography showed a hypoechoic testis without testicular torsion. He was diagnosed with testicular infarction and a scrotal abscess due to Pseudomonas aeruginosa, and was treated with cefepime along with transcutaneous drainage. Despite the antimicrobial treatment, he experienced testicular loss with necrotic tissue. Because little is known about the risk factors, clinical characteristics, management, and prognosis of testicular infarction secondary to epididymitis, we performed a systematic review of the literature. Conclusion This is a case of testicular necrosis during the treatment of epididymitis with negative urine culture and detection of Pseudomonas aeruginosa in tissue culture. Clinicians should perform frequent blood flow evaluation to the testis for early urologic intervention.

Endovascular aneurysm repair (EVAR) is a common modality of treating abdominal aortic aneurysms (AAA). Common complications include endoleak, bleeding, infection, contrast related injuries, and ischemia. We present the case of a patient who experienced a testicular infarction following repair of an infrarenal AAA. We also discuss the implications for this complication and review the available literature for similar cases and treatment options.

The incidence of segmental testicular infarction (STI) is very low. Such a disorder most often affects young men. The most common symptom is sudden testicular pain. We report 6 cases of men diagnosed with STI. Clinical examination, blood test, urine analysis, and ultrasound examination with colour Doppler were performed. Furthermore, tissue sonoelastography or MRI was performed in selected patients. All men underwent surgical exploration. In all but one man, the affected testis was preserved. Although STI is a rare condition, it should be taken into account if testicular pain prior to suspicious ultrasound imaging occurs. To be aware of this benign testicular pathology and its clinical and imaging features is important to avoid unnecessary orchiectomies in young patients.

Segmental infarction of the testicle secondary to epididymo-orchitis is a rare condition which can be difficult to diagnose and can lead to loss of the testis. We report a case of a 72-year-old man who presented with two weeks of worsening pain of his left testis despite oral antibiotic treatment for epididymo-orchitis. A testicular ultrasound initially revealed a suspected intra-testicular abscess. Despite intravenous antibiotics, his symptoms worsened. A repeat ultrasound demonstrated an increase in size of the lesion and a decision was made to take him to theatre. Intra-operative findings instead revealed a segmental area of testicular infarction requiring debridement.

Testicular infarction is a rare consequence of inguinal hernia repairs. Ischaemic orchitis leading to testicular atrophy occurs in 0.2-1.1% of all inguinal hernia repairs. This case report describes a 52 year old male patient who developed testicular infarction three days post-open inguinal hernia mesh repair. Commonly, ischaemic orchitis is caused by damage to the pampiniform plexus which leads to venous congestion and acute thrombosis. The risk factors for developing testicular ischaemia include large or recurrent hernias. It is thought that open approaches have a higher risk of causing ischaemic orchitis compared to the laparoscopic approach due to the need for greater manipulation of the spermatic cord. However, some studies suggest that both approaches do not reduce testicular perfusion post-operatively. Nevertheless, larger studies need to be conducted to evaluate this further and patients should always be informed about this risk regardless of its rarity.

Segmental testicular infarction is a relatively rare acute or subacute condition which is infrequently thought of in the differential diagnosis for testicular pain. However, missing or misdiagnosing this entity on clinical evaluation and/or imaging has significant implications for patients as they may undergo unnecessary surgery for suspected testicular torsion or tumor. Knowledge and recognition of the features of segmental testicular infarction on ultrasound and MRI will aid in the diagnosis of this disease early in the patient's course. The common imaging features of segmental testicular infarction and the clinical literature are reviewed, with an emphasis on ultrasound, utilizing seven recent cases from three institutions.

Segmental testicular infarction is a rare cause of acute scrotum. Its aetiology is not well defined and it can be clinically confused with a testicular tumour. Because the differential diagnosis between segmental testicular infarction and testicular tumour can be difficult, most authors in the past recommended surgery. Imaging plays an important role in the preoperative diagnosis, with a colour Doppler ultrasonography as the investigation of choice although magnetic resonance imaging (MRI) can be useful in doubtful cases. The objective of this retrospective study was to describe the radiologic findings and the outcome of conservative management in a single-centre experience of 19 cases of segmental testicular infarction.

Segmental testicular infarction is a rare entity with fewer than 40 cases documented in the literature. It frequently mimics an acute scrotum presenting with pain and swelling. Difficulty distinguishing benign from malignant lesions on imaging has led to radical orchiectomy in the past. With improvements in imaging, this condition may be treated more conservatively. We present the first case of bilateral segmental testicular infarction and discuss management options.

Epididymo-orchitis rarely leads to abscess formation and global testicular infarction/loss, particularly in the setting of appropriate antibiotic therapy. The imaging modality used when monitoring for testicular ischemia is ultrasonography. However, as described in the literature, testicular pathology may not be evident on routine imaging. We describe two cases of recurrent bacterial epididymo-orchitis, complicated by testicular abscess resulting in testicular infarction. This rare, nevertheless significant, complication occurred in both patients despite receiving appropriate extended antibiotic therapy. Both cases demonstrate the limitations of ultrasonography alone, suggesting that a high level of clinical suspicion must be maintained when ultrasound evaluation proves to be inconsistent with the clinical presentation. These cases demonstrate the importance of monitoring for warning signs of ischemia, as early recognition may lead to reperfusion interventions and ultimately testicular salvage.

Testicular Infarction in the Presence of Epididymitis: An Anatomo Clinical Continuum? Epididymitis is an inflammation limited to the epididymis, common cause of acute scrotal pain and usually responsive to antibiotics, non-steroidal and anti-inflammatory drugs. Nevertheless complications such as orchitis and abscess may occur; a testicular infarction is less frequent. We are going to discuss two cases of segmental testicular infarction both associated with epididymitis. The first one developed in a massive hemorrhagic infarction after performing a not responsive homolateral epididymitis to conservative therapy and subsequent orchiectomy was performed. The second one was treated with successful medical therapy and complete restoration of testis. We reviewed the pertinent literature in terms of differential diagnosis, etiology with particular interest in physiopathological mechanisms of testicular infarction giving an original etiologic hypothesis.

Testicular torsion is a true vascular emergency - prompt diagnosis and surgical management is critical. If treatment is not instigated within 4-6hours of the onset of pain, irreversible testicular infarction may result, necessitating orchidectomy. This review presents the key features, management principles and medicolegal considerations of this serious condition.

Neonatal testicular infarction is a rare occurrence. We report on a newborn infant with bilateral testicular infarction. At birth, the uncut umbilical cord ran taut between the thighs making a complete loop around the genitals, compressing the testes. At the age of 6 hours, because of increasing agitation and the beginnings of scrotal discoloration, the infant was operated on, showing a bilateral testicular infarction potentially induced by strangulation of the twisted umbilical cord. Here, we discuss the clinical findings of neonatal testicular infarction and give advice as to the management of this serious complication with regard to the available published data.

One of the most common urgent urologic problems seen in young patients in the emergency department is the acute scrotum. Testicular infarction from an incarcerated inguinal hernia is an unusual presentation and often not considered in the initial evaluation. Herein, we present an interesting case of a 28 day old boy who presented with an acute scrotum and was found to have a testicular infarction and an incarcerated inguinal hernia. The management of similar cases in young males may vary depending on which surgical service is consulted initially and a scrotal ultrasound should be done without any delay.

Epididymo-orchitis is a common diagnosis in men presenting with unilateral testicular pain. It can be of an infectious or non-infectious aetiology. Clinical examination and laboratory investigations do not reliably differentiate testicular infarction secondary to epididymo-orchitis from uncomplicated epididymo-orchitis. Definitive diagnosis is usually made by ultrasound. Misdiagnosis and under-treatment can lead to poor outcome, such as infarction and loss of the affected testis. We present an uncommon case of epididymo-orchitis resulting in testicular infarction and rupture despite normal initial investigations.

The purpose of this study was to evaluate the usefulness of the main methods of diagnostic imaging in patients with segmental testicular infarction (STI) for obtaining accurate clinical and therapeutic approaches.Between January 2004 and January 2011, 798 patients were examined with colour Doppler ultrasound (CDUS) for disease of the scrotum. Fourteen patients with CDUS findings suspicious for STI were subjected to magnetic resonance imaging (MRI). In five patients, contrast-enhanced ultrasonography (CEUS) was performed.CDUS showed hypoechoic avascular areas suspicious for STI in 14 patients (1.75%). MRI confirmed the presence of predominantly hypointense lesions in T1- and T2-weighted sequences, with perilesional vasculature and no intrinsic contrast enhancement in 13 patients. In follow-up examinations, these abnormalities gradually decreased. This finding was confirmed in the five patients examined with CEUS. Only in one case did MRI reveal discrete intralesional contrast enhancement after injection of contrast medium, and the lesions appeared stable during the CDUS and MRI follow-up; this patient underwent orchiectomy, with a diagnosis of B-cell lymphoma.In our experience CDUS, CEUS and MRI proved indispensable for accurate clinical and therapeutic approaches in suspected STI.

The acute scrotum is a common emergency department (ED) presentation and can be defined as any condition of the scrotum or intrascrotal contents requiring emergent medical or surgical intervention. Although rarely fatal, acute scrotal pathology can result in testicle infarction and necrosis, testicular atrophy, infertility, and significant morbidity. Scrotal US is best performed with a linear 7.5- to 12-MHz transducer. In addition to imaging in the longitudinal and transverse planes, it is helpful to obtain simultaneous images of both testes for comparison. Color Doppler is used to evaluate for abnormalities of flow and to differentiate vascular from nonvascular lesions. Attention to appropriate color Doppler settings to optimize detection of slow flow is critical. The evaluation of acute scrotal pain can be challenging for the clinician initially examining and triaging the patient. Acute scrotal conditions due to traumatic, infectious, vascular, or neoplastic etiologies can all present with pain as the initial complaint. Additionally, the laboratory and physical examination findings in such conditions may overlap; this, coupled with potential patient guarding and lack of collaboration, may result in a limited, non-specific physical examination. Therefore, scrotal ultrasound has emerged to play a central role in the evaluation of the patient presenting with acute scrotal pain. In conclusion, we are firmly convinced that a scrotal ultrasound should always be performed in the presence of acute scrotal pain. Moreover, urologist should be able to perform a scrotal ultrasound but, if imaging does not supply a clear diagnosis, surgical exploration is still mandatory.

We report a case of a 50-year-old male who presented to the Emergency Department and was diagnosed with epididymo-orchitis. Sonographic evaluation of the testicle initially showed a normal, low resistance color Doppler waveform. The patient was admitted to the hospital. A follow up sonogram two days later demonstrated reversal of diastolic arterial flow on Pulse-Wave color Doppler imaging. Reversal of diastolic blood flow in testicular color Doppler sonography is a sign of impending infarction. On hospital day 6, the patient had a follow up ultrasound which demonstrated infarction of the testicle. Pathology confirmed the diagnosis and the tissue culture grew E. coli and Candida Albicans. This case documents the rapid progression of epididymo-orchitis with a normal spectral waveform to testicular infarction with reversal of diastolic blood flow on color Doppler imaging as a sign of impending infarction.

A 19-year-old boy presented with a 48-hour history of acute onset severe right scrotal pain with minimal scrotal swelling. High-frequency US including color Doppler demonstrated a wedge-shaped, heterogeneous, avascular testicular mass diagnosed preoperatively as a segmental testicular infarction (STI). This was proved at surgery and subsequent histology. The preoperative diagnosis of STI was suggested based on the young man’s presentation of severe pain and the sonographic appearance of the mass. Entertaining the preoperative diagnosis of STI from a testicular tumor is important for testis-sparing surgery even though STI in the pediatric age group is extremely rare.

Segmental infarction of the testis represents a rare entity in that there have been fewer than 40 cases documented in the literature. Like global infarction, segmental infarction of the testis can masquerade as a mass lesion or torsion of the testis. Reported herein is a very rare case of segmental testicular infarction due to atheroembolism in a 58-year-old man. The patient presented with severe left testicular pain and underwent left high orchiectomy on the clinical diagnosis of testicular torsion. The testis had a segmental hemorrhagic necrosis around which many cholesterol emboli were observed. This is the first report to describe cholesterol embolism-associated segmental testicular infarction.

We report an unusual case of a 28-year-old male with constitutional symptoms and bilateral testicular pain. After diagnosis of cytomegalovirus (CMV) hepatitis, his constitutional symptoms and testicular pain worsened despite treatment for epididymoorchitis. Ultrasound was concerning for infarction. Exploration in the operating room revealed bilateral testicular infarction requiring bilateral orchiectomy with subsequent androgen hormone replacement. Pathologic diagnosis was polyarteritis nodosa (PAN). PAN is a rare systemic vasculitis that affects multiple organs. There are no previous reports of PAN-induced vasculitis leading to bilateral testicular infarction and bilateral orchiectomy.

Idiopathic testicular infarction is a rare cause of acute scrotal pain and usually misdiagnosed as other more common diseases because of similar manifestations. We present a case that was initially misdiagnosed as urolithiasis and acute epididymitis. Correct diagnosis was made only after repeated color Doppler ultrasonography and surgical exploration. This reminds us to keep alert for such patients because delayed or false diagnosis would result in unnecessary antibiotics use, patient suffering, and even orchiectomy. If diagnosis remains uncertain after clinical evaluation, early surgical exploration is suggested.

Segmental testicular infarction is a rare clinical entity with various causes. We report the gray-scale and color Doppler sonographic findings of a case of segmental testicular infarction associated with varicocelectomy. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:143–145, 2006

Hemorrhagic infarction of the testicle is an unusual occurrence in the newborn infant. It usually develops as a consequence of torsion of the spermatic cord. We report a case of global testicular infarction in a newborn associated with a tense hydrocele.

Segmental testicular infarctions are a rare disease with a low prevalence and few cases have been reported in the literature. We present a 26-year-old male without any relevant medical history who consulted at the Urology Department due to mild pain in the right testicle over the last month. He had no previous trauma or acute testicular pain. Partial orchiectomy was performed through an inguinal incision with removal of lesions and reconstruction of the testicular parenchyma. Histological examination revealed testicular infarction with no presence of neoplastic cells.

Summary We report a case of segmental testicular infarction occurring in a 24-year-old African Malian man who presented with a complaint of sudden and severe left testicular pain for 4 days. Scrotal ultrasound showed a hypoechoic mass in the left testicle. The hypoechoic area demonstrated no blood flow in colour Doppler mode. The patient underwent a left testicular exploration. A partial orchiectomy was performed with complete excision of the lesion. Pathological evaluation revealed a segmental testicular haemorrhagic infarction.

Segmental (partial) testicular infarction is a very rare condition of unknown cause in more than 70% of cases. Several predisposing conditions have been described, but to our knowledge, this is the first documented case and often overlooked complication occurring as a result of cysto-prostatectomy. It usually presents in an acute manner resembling testicular torsion or epididymo-orchitis and is confirmed using ultrasonography. In some cases, it may present insidiously with no pain and may be confused with a testicular tumor due to the hypo-echoic features on imaging. In unclear situations, Doppler sonography shows vascularity and a magnetic resonance scan can be useful to distinguish between the two conditions.

Fibrous pseudotumor of the tunica vaginalis testis is an uncommon lesion of unknown pathogenesis. Although this reactive process of testicular tunics is benign, this usually is diagnosed after radical orchiectomy. The authors describe a case of fibrous pseudotumor of the tunica vaginalis testis associated with testicular infarction. To our knowledge, this is the first case presented with similar association, second case consisting predominantly of myofibroblasts and the fourth reported case encountered in childhood. Copyright (C) 2001 by W.B. Saunders Company.

Summary To the authors' knowledge, this case is unique to the emergency medicine literature. Although testicular infarction from epididymitis is rare, it should be considered as a complication of severe or unresolving epididymitis. These patients should be Dlaced on broad spectrum antibiotcs, i.e., quinolones; color flow Dopp-er of the testes should be obtained; md urologic consultation should be onsidered for possible admission ind surgical exploration.

We report a case of segmental testicular infarction occurring in a patient with sickle cell trait. A 20-year-old African American man presented with a complaint of sudden onset, acute severe left testicular pain for 24 hours. Scrotal ultrasound revealed a hypo-echoic mass in the left testicle. The hypo-echoic area demonstrated no blood flow in Doppler mode. Because malignancy could not be excluded, the patient underwent a standard inguinal testicular exploration. A partial orchiectomy was performed with complete excision of the lesion. Pathology revealed infarcted testicular tissue with no malignancy present. Further evaluation revealed that the patient had sickle cell trait unbeknownst to him.

Segmental testicular infarction is described in 11-years-old-child presented with acute left hemiscrotal pain and swelling. Clinical examination suggested left testicular tenderness with no evidence of intratesticular mass and the rest of the scrotal contents were normal. Color doppler study suggested a well circumscribed avascular lesion in the upper pole of left testis and provided a clue to diagnosis. Partial orchidectomy resulted in a satisfactory recovery and provided histopathological confirmation of diagnosis. Authors review their experience with this rare entity and the pertinent literature.

Background: Complicated inguinal hernias pose a threat to the life of the child as well as increase the morbidity associated with management of an otherwise straightforward condition. The aim of this study was to determine the presentation, treatment and management outcome of complicated inguinal hernias in children.Materials and Methods: A retrospective study of all children 15 years and less managed for complicated inguinal hernia between 2002 and 2010. Data obtained included demographic characteristics, presentation, operative fi ndings and outcome.Results: Complicated hernia rate was 13.9%.There were 41 children, 38 boys (92.7%) and 3 girls. Ages ranged between 4 days and 15 years(Median = 90days). Most were infants (48.8%, n = 20) and neonates accounted for 19.5% (n = 8). Median duration of symptoms prior to presentation was 18 h (range = 2–96 h). Seven patients had been scheduled for elective surgery. Hernia was right sided in 68.3% (n = 28). Symptoms included vomiting (68.3%), abdominal distension (34.1%) and constipation (4.9%); one patient presented with seizures. In 19 (46.3%)patients hernia was reducible while 22(53.7%) had emergency surgery. Associated anomalies included undescended testis (12.2%), umbilical hernia (14.6%). Intestinal resection rate was 7.3% and testicular gangrene occurred in 14.6%. Mean duration of surgery was 60.3 ± 26.7 min. Wound infection occurred in six patients (14.6%). Overall complication rate was 24.4%, 30% in infants. The mortality rate was 2.4% (n = 1).Conclusions: Morbidity associated with complicated inguinal hernia is high in neonates and infants. Delayed presentation is common in our setting. Educating the parents as well as primary care physicians on the needfor early presentation is necessary.Key words: Bowel gangrene, complicated hernia, incarcerated hernia, testicular infarction

We report a case of segmental infarction of the testis associated with scrotal pain diagnosed by color Doppler ultrasound. Histological examination of the testis confirmed the diagnosis. Use of this imaging modality may obviate surgical exploration in select cases.

Segmental testicular infarction is a rare cause of an acute scrotum. The etiology can be related to sickle cell anemia, hypersensitivity angiitis and polycythemia in some cases, but the condition is usually an idiopathic phenomenon. Because making the differential diagnosis between segmental testicular infarction and testicular tumor can be difficult, most authors have recommended surgery in the past. We report here on cases of testicular segmental infarction that were treated by conservative management and we describe the radiologic findings. (Korean J Urol 2008; 49:574-578)

Segmental testicular infarction is a very rare entity. We present a case in a patient with prior retroperitoneal surgery who developed segmental infarction after routine vasectomy.

We present the case of a 12-year-old boy with testicular infarction secondary to Wegener’s granulomatosis. Scrotal exploration revealed no evidence of testicular torsion. The testis was left in place, and, after systemic therapy, partial reperfusion was present.

A case of neonatal segmental testicular infarction in 1 testicle with complete infarction in the contralateral testicle is reported. Postoperative testicular function was documented by serum testosterone assay. To our knowledge this is the first case of neonatal testicular salvage in this setting documented by serum testosterone level. We hypothesize that vascular injury secondary to birth trauma was the likely cause in our case. The similarities and differences between this entity and neonatal extravaginal torsion of the spermatic cord are discussed.

Three patients with neonatal testicular torsion and infarction (two bilateral, one unilateral) are presented with a distinctive sonographic appearance. All five testes appeared inhomogeneously hypoechoic and each was surrounded by a brightly echogenic rim. Whereas surgical exploration was required in the past to establish the diagnosis of testicular infarction in the neonate, sonographic demonstration of the abnormality in the appearance of the testicular parenchyma permits nonoperative diagnosis. Because surgical salvage of the testis in the setting of neonatal extravaginal torsion is thought to be quite rare, the necessity of removing the testis is less clear when the diagnosis is established preoperatively.