A rare case of bilateral testicular torsion in a 57-year-old man.

CONTEXT:Testicular torsion, the twisting of the testis or spermatic cord, places the testis at risk of vascular compromise and is a surgical emergency. Testicular torsion is predominantly unilateral (98% of torsion cases) and primarily affects neonates and adolescents in a bimodal distribution. Bilateral testicular torsion is exceedingly rare (2% of cases) and is associated with neonates. To the authors' best knowledge, there have been no reports of bilateral torsion in adult males over the age of 24. CASE DETAILS:A 57-year-old man presented to the emergency department 9 days after developing testicular pain while lifting his lawnmower. Ultrasonography performed at an outside facility was unremarkable. He was encouraged to followup with urology as an outpatient. Despite outpatient analgesia, he continued to experience pain and returned to the ED, where repeat ultrasonography demonstrated bilateral torsion with hypoperfusion. DISCUSSION:Although testicular torsion is uncommon, the clinician must recognize torsion; if left untreated, torsion leads to infertility. Previous publications suggest that ultrasonographic findings of bilateral testicular torsion should be attributed to "technical failure" rather than a plausible diagnosis. However, this case demonstrates the importance of maintaining a high index of suspicion, especially with an atypical age range and pathological presentation, particularly among men during their reproductive years.