Abdominal pain in teenagers: Beware of testicular torsion.

Background/purpose: Testicular torsion (TT) remains an important cause of testicular loss. Subtle presentations, such as abdominal pain, may be responsible for late diagnosis and increased testicular loss. This study assesses the influence of pain onset location over testicular outcome.
Methods: Data of children 17 years and younger submitted to surgical treatment for TT by our department from January 2017 to December 2018 were collected. Demographics, clinical presentation and outcome were reviewed.
Results: 73 patients (median age of 15.3 years old) were included in the study. 22% (16/73) patients presented with abdominal pain. When compared to patients with initial testicular pain, patients with abdominal pain showed a significant delay in TT diagnosis/treatment (median pain duration of 36 h vs 5 h) and a significantly higher rate of testicular loss [81% (13/16) vs 4% (2/57), p < 0.001]. The majority of testicular losses (68%, 13/19) occurred in patients with abdominal pain. In patients with abdominal pain, TT was initially overlooked in 69% (11/16) of cases, resulting in 81% (9/11) gonadal loss; none of these 11 patients were initially evaluated by a surgeon. All patients with testicular pain were evaluated in order to exclude TT.
Conclusions: Abdominal pain is a frequent presentation of TT, being an important cause of delayed diagnosis/treatment and associated higher testicular loss rate.
Type of Study: Treatment study.
Level of Evidence: Level III.
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