By: 2nd GROUP

Badiatul Khilqoh (6130014011)

Claudia Narinda R. P. (6130014012)
Dinda Mutiara S. P. (6130014013)
Maimunah Faizin (6130014014)
Elsa Kusumawati (6130014015)
Nuris Umi Rizqi (6130014016)
Hessty Rochendah O. (6130014017)
Sri Safariawati M. A. A. (6130014018)
Luthfi Kalindra P. (6130014019)
Aanisah Ikbar S. (6130014020)
A 17-year-old man came to the ER with pain in the left scrotum, a sudden pain since waking up at 3 am to
the ER. Pain does not diminish with position changes. The body feels a bit feverish (sumer-sumer).
Urinate little pain / dysuria.
History:
Pain in the creeping inguinal region, fever
Physical examination:
General condition is enough, TD 120/80, RR 28x / min, T 370 C, GCS 456
The scrotum enlarges due to edema
Inspection: left scrotum hyperemic edema, high scrotal, position tends horizontally, angle sign (+)
Palpation: tenderness of the testis sinistra, phren test (+)
Head / Neck: Normal; Abdomen: Normal; Thorax: Normal
Suprapubic tender (-), Renal pain tender (-), cremaster reflex (-)
Supporting investigation:
Blood: Hb 14,3 gr / dL, Leukosit 12,500 UI
Urinalysis: pH 5, yellow, 1.015, nitrite (-), protein (-), glucose (-), urine sediment: erythrocyte 0-1 / field of
view, leukosit 10-15, bacteria (-), leukocyte cylinder (+) BUN 16 mg / dL, creatinine 0.6
Ultrasound: the testis sinistra visible vascularisation / avascular testis, peritesticular tissue swelling
1. Left and sudden pectoral pain, not diminished by
changes in position
2. Fever
3. Dysuria
4. Hipovascularization
5. The position of the left testis tends to be horizontal
6. Angle sign (+)
7. Cremaster reflex (-)
8. Phren test (+)
 Based on anamnesis and physical examination in
the form of angle sign (+), phren test (+) and located of
testis is more horizontal from the contralateral side, the
patient is suspected of having a testicular torsion
1. Be able to explain the embryological development of the
testes
2. Be able to explain the anatomy and physiology of the testes
3. Being able to know the diagnosis and differential diagnosis
4. Be able to explain the etiology and risk factors of diagnosis
5. Be able to explain the pathophysiology of the diagnosis
6. Be able to explain the clinical manifestations of the diagnosis
7. Be able to explain the management of the diagnosis
8. Be able to explain the complications and the prognosis of the
diagnosis
 Each has an average length of more than half a meter, and is the site of sperm
formation. The sperm is then fed to the epididymis, another tubule that is also
in the form of a coil with a length of about 6 m. The epididymis empties into
the vas deferens, which enlarges into an amperes vas deferens just before the
vas deferens enters the corpus of the prostate gland (Guyton and Hall 2006).
Two seminal vesicles, each located adjacent to the prostate, empty into the tip
of the ampullary prostate, the mission of the ampulla or the seminal vesicle
enters the ejaculatory duct into the prostate gland corpus and empties into the
internal parsal urethra. The prostatic ducts also originate from the prostate
gland into the ejaculatory ducts and from here to the prostatic parse urethra
(Guyton and Hall 2006).
Finally, the urethra is the last linking chain of testicles to the outside world.
Urethra is supplied with mucus derived from a large number of small urethral
glands located along the urethra and even further from the bilateral
bulbouretral gland located near the urethral origin (Guyton and Hall 2006)
The twisting of spermaticus funikulus results in impaired
blood flow in the testes. This situation affects 1 in 4000
men less than 25 years old, most of whom are suffered by
children at puberty (12-20 years). In addition, not
infrequently the fetus is still in the uterus or newborns
suffer from undiagnosed torque testis resulting in loss of
the testis both unilateral and bilateral.
 Patients usually complain of severe pain with sudden
onset and testicular swelling. The pain may spread to
the folds of the thighs and lower abdomen, so it is often
confused with appendicitis unless a careful physical
examination of genetals is performed.
Acute scrotum: severe pain in the scrotum area, which
is sudden and followed by swelling of the testes.
Pyrexia is very rare unless the appearance is slow and
the testic is necrotic.
Pain accompanied by nausea and vomiting
In infants the symptoms are not typical of anxiety,
fussiness, or unwilling to breastfeed.
Manual Detection
Manual detection is to restore the position of the testis to its
origin, ie by turning the testis in the opposite direction of
the torque.
Operation
This surgical action is intended to restore the position of the
testis in the right direction (reposition) and after that a
testicular viability assessed torsio, may still be viable or
already experiencing necrosis.
Orkidopeksi is performed by using unabsorbed yarns in 3
places to prevent the testis not being re-twisted, whereas in
testicular testicular testis (orkidectomy)
 1. Testicular atrophy
2. Necrosis of the testes
3. Torsio recurrence
4. Wound infection
5. Subfertility
6. Cosmetic deformity
A good prognosis when handling is less than 6 hours
post-symptom and when it is 24 hours then performed
an orchidectomy.
 In the case of this scenario, the patient complains of
pain in the left scrotum of a sudden nature and does not
diminish the pain when changing positions. On physical
examination, the left testis position tends to be horizontal
from the contralateral side, angle sign (+), phren test (+). It
can be concluded that the patient has a testicular torsion,
where the most important cause in general is congenital
abnormalities. Other factors that may affect the occurrence
of testicular torsion are trauma and excessive movement.
Testicular torsion should be treated immediately before 6
hours for good results, more than that can worsen the
prognosis.