A CARE-compliant article successful salvage of bilateral perinatal testicular torsion after delivery out of breech presentation

Rationale: Neonatal testicular torsion is a rare condition. There is no consensus about the optimal surgical treatment of neonatal testicular torsions. The salvage rate reported in literature remains poor. Discrimination of the onset of a neonatal testicular torsion seems to have an important impact of the salvage rate. Deliveries out of breech presentation have a risk for neonatal complications including neonatal genital birthtrauma. Patient concerns: A newborn boy, who was delivered at 40 weeks of gestation out of breech presentation, showed shortly after birth, a painful discoloration and swelling of the scrotum. Diagnosis: Clinical examination and ultrasound were highly suspicious for testicular torsion. Intervention: Emergency surgery revealed a bilateral testicular torsion with dark coloration of both testicles. The testicles were detorted and left in situ. A bilateral orchidopexy was performed. Outcomes: Postoperative ultrasound showed reperfusion of both testicles and the boy was discharged from hospital. Follow-up after 2 months showed normal clinical examination and sonographically persistent perfusion of both testicles. Endocrinological investigations during minipuberty revealed normal hormonal values. Lessons: We present this rare case in regard to the current literature and recommend close observation of newborns for genital trauma after delivery out of breech position. We encourage surgeons to carefully consider leaving the testicles in situ.