If the torsion occurs in utero then the testis may be small or absent.
If the torsion occurs in the perinatal period then:
(1) usually one (rarely both) scrotum is discolored and swollen at birth
(2) the affected scrotum is red, blue or purple in color
(3) typically painless and nontender or slightly tender
These findings should prompt immediate exploration of the scrotum in an attempt to salvage the affected testis.
Orchiectomy of the affected testis should be performed if one or more of the following is present:
(1) a prolonged period of torsion has occurred with obvious infarction, or
(2) blood flow does not rapidly return after detorsion
(3) incision of the testis after detorsion is not followed by fresh bleeding (Giacomantonio and Lau)
It has been hypothesized that leaving a marginal testis in situ can result in immunologic injury to the contralateral testis, similar to immune injury to an eye.
If torsion of the affected testis is intravaginal and it is not removed then orchipexy (fixation) is performed. This is not necessary if the torsion is extravaginal. If orchipexy is performed on the affected side then the contralateral testis is also usually fixed
