WOFAPS 2025 8th World Congress of Pediatric Surgery

Senda Houidi, Fatma Thamri, Abir Jouini, Melek Mezni, Yosra Kerkeni, Riadh Jouini

children hospital Bechir Hamza, Pediatric surgery department A Tunis Tunisia

Introduction:

Bilateral Synchronous neonatal testicular torsion (BSNTT) constitutes a rare and tragic event that can lead to testicular loss and infertility if not promptly diagnosed and treated. This study aims to review the current literature on BSNTT and present a case series to improve understanding of this condition.

Materials and methods:

A retrospective review of neonatal cases diagnosed with BSNTT over a 10-year period was conducted. Data collected included patient demographics, clinical presentations, diagnostic imaging, surgical findings, and outcomes. Additionally, a thorough literature review was performed using databases covering publications from 1997 to 2024.

Results:

Three neonates with BSNTT were identified, presenting at a median age of 3 days (range 1-7 days). Common symptoms included scrotal swelling, discoloration, and irritability in 83% of the cases. Ultrasonography, the primary diagnostic tool, showed inhomogeneous testicles with hypoechogenic areas in all cases and characteristic whirlpool signs in three cases. Surgical exploration, conducted via inguinal and scrotal incisions after an average delay of 5.5 ± 1.6 hours, revealed gangrenous testicles detached from the scrotal wall and twisted at least 720° in an extravaginal manner. Detorsion was attempted, resulting in successful testicular salvage in four cases, while two required orchiectomy. After 24 months of follow-up, two patients had successfully salvaged at least one testis. A literature review identified 32 additional cases, showing a consistent pattern of late presentation and variable success in testicular salvage.

Conclusion:

BSNTT is a rare but devastating condition that requires a high index of suspicion and rapid surgical intervention to maximize the chances of testicular salvage