A case of acute scrotum with an extremely rare etiology - extravaginal testicular torsion in adult male

Extravaginal torsion (EVT)  of the testis occurs almost exclusively in neonates, being the most common mechanism of torsion in the fetus and newborn. In this condition, the spermatic cord is twisted outside the sack of tunica vaginalis in the scrotum. Unlike the intravaginal torsion reported in older children and adults, this entity is considered to have a different surgical anatomy. The incidence of intravaginal testicular torsion in patients under 25 years of age is estimated at around 1 per 4000, however, extravaginal testicular torsion in adults is an extremely rare entity. We present the case of a healthy 22-year-old patient who was admitted to the emergency room with right hemi-scrotal pain, tenderness, and swelling with acute onset of 8 hours. His initial evaluation included color doppler ultrasound that revealed a twisted right cord with no intratesticular vascular flow. The patient underwent emergency scrotal exploration revealing a 360° counterclockwise extravaginal torsion of the right testis. Testicle regained normal aspect after detorsion, and 3 point orchidopexy was performed. Recovery was uneventful and color doppler ultrasound revealed normal vascular flow 15 days after surgery.