Testicles_twisting_in_newborn 👤👶

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Neonatal Testicular Torsion: Causes, Symptoms & Treatment

Neonatal Testicular Torsion is a rare but serious condition in which a newborn baby’s testicle twists around the spermatic cord. This twist blocks blood supply to the testicle, leading to swelling, pain, and risk of permanent damage if not treated quickly.

It can occur before birth (in-utero torsion) or soon after birth.

What Is Testicular Torsion in Newborns?

Testicular torsion happens when the tissues supporting the testicle aren’t fully developed or are too loose. Because of this, the testicle rotates and cuts off blood flow.

In newborns, this is usually extravaginal torsion, meaning the entire testicle, cord, and surrounding tissues twist as a unit.

Causes

While the exact cause is not always known, common factors include:

  • Loose or underdeveloped connective tissue around the testicle

  • Abnormal fetal positioning inside the womb

  • Difficult or prolonged labor

  • Low birth weight or prematurity

  • Reduced attachment of the testicle to the scrotum

  • Trauma (rare)

Most cases occur before birth, meaning symptoms may be present immediately after delivery.

Symptoms in a Newborn

Unlike older children, a newborn cannot express pain. Parents and doctors must look for physical signs:

1. Swelling of the scrotum

  • One side of the scrotum appears larger, firm, or hard

2. Redness or bluish discoloration

  • The scrotal skin may appear red, dark, or purplish

3. High-riding or abnormally positioned testicle

4. Feeding difficulty or irritability

  • General discomfort but no specific cry for scrotal pain

5. Absence of cremasteric reflex

  • Gentle stroking of inner thigh normally lifts the testicle — may be absent

6. No improvement over time

  • Swelling persists and may worsen

Diagnosis

Doctors diagnose testicular torsion through:

  • Physical examination

  • Scrotal ultrasound with Doppler
    (checks the blood flow to the testicle)

  • Urgent specialist evaluation (pediatric surgeon/urologist)

Is This an Emergency?

YES. Testicular torsion is a surgical emergency.
Immediate medical attention is required.

However, in newborns, because torsion often happens before birth, blood flow may already be severely compromised. Even then, prompt evaluation is essential to save the testicle or prevent further complications.

Treatment

1. Emergency Surgery (Detorsion)

If detected early, doctors may try to untwist the testicle and restore blood supply.

2. Orchiectomy (removal of damaged testicle)

If the testicle is already non-viable due to long-term loss of blood flow.

3. Fixing the opposite testicle

The healthy testicle is usually stitched in place (orchiopexy) to prevent future torsion.

Outcomes

  • If torsion happens before birth, saving the testicle is challenging because damage occurs within hours.

  • If torsion happens after birth and is recognized early, outcomes can be good.

  • The baby can live a normal life with one healthy testicle — normal fertility and hormone levels are usually maintained.

Prevention

Unfortunately, torsion cannot be prevented in most newborns because it occurs suddenly and without warning. Early detection and urgent care offer the best chance for recovery.

When Should Parents Seek Immediate Help?

Seek urgent medical attention if you observe:

  • Swelling or hardness in one side of your newborn’s scrotum

  • Sudden change in color (red, purple, blue)

  • Baby crying inconsolably without obvious reason

  • A noticeable difference in the size or position of testicles

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