Equis ISSN 2398-2977

Spermatic cord: torsion

Synonym(s): Testicular torsion

Contributor(s): Terry Blanchard, Graham Munroe, Elaine Watson, Madeleine L H Campbell

Introduction

  • Torsion of the spermatic cord may be 180 or >360° rotation about its longitudinal axis.
  • Cause: unknown.
  • Signs: >180° torsion causes signs of colic; torsion of 180° or less rarely causes signs.
  • Diagnosis: palpation, ultrasonography, exploratory surgery.
  • Treatment: unilateral castration if the torsion is severe enough that the affected testicle is non-viable or if the damage is severe enough to result in degeneration of that or the contralateral testis, eg to heat.
  • Prognosis: good.

Pathogenesis

Etiology

  • Unknown.
  • 180° torsion probably develops during testicular descent.
  • Possible factors include elongation of the caudal ligament of the epididymis or proper ligament of the testis and/or and excessively long mesorchium. Contraction of the cremaster muscle may initiate rotation which is not inhibited by the increased length of the caudal ligament.

Predisposing factors

General

  • Young adult stallion.

Pathophysiology

  • Usually occur in descended testes but has been recorded in cryptorchidism. More commonly unilateral.
  • 180° torsion is usually an incidental finding; probably occurs during testicular descent.
  • 180° torsion may occur during testicular descent → tail of epididymis lies cranial to the testis → may be uni- or bilateral → usually no pronounced effect on libido or semen quality, but it is interesting that in many permanent cases of 180° unilateral spermatic cord torsion, the testis is slightly smaller than the unaffected contralateral testis.
  • 180° sporadic or permanent bilateral spermatic cord torsions also occur, usually with no significant problems.
  • >180° torsion causes signs of colic.
  • Infarction of the testis follows vascular strangulation of the vessels in the spermatic cord. The thin-walled veins are more likely to be affected than the thick-walled arteries.
  • >180° torsion → severe vascular compromise and venous obstruction leading to hemorrhagic infarctions and localized edema. Arterial occlusion results in ischemic necrosis of all contents distal to torsion. The testis is under pressure, swollen and painful.

Timecourse

  • <180° torsions can be permanent or occur intermittently.
  • >180° torsions usually occur acutely.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Morresey P R (2007) The enlarged scrotum. Clin Tech Equine Pract 6 (4), 265-270 VetMedResource.
  • Pozor M A & McDonnell S (2002) Doppler ultrasound measurement of testicular blood flow in stallions. Theriogenology 58 (2/4), 437-440 VetMedResource.
  • Threlfall W R, Carleton C L, Robertson J, Rosol T & Gabel A (1990) Recurrent torsion of the spermatic cord and scrotal testis in a stallion. JAVMA 196 (10), 1641-1643 PubMed.
  • Pascoe J R, Ellenburg T V, Culbertson M R & Meagher D M (1981) Torsion of the spermatic cord in a horse. JAVMA 178 (3), 242-245 PubMed.


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