Occasionally lower abdominal pain may be due to a congenital abnormality where the connective tissue support of the testicle is slightly unstable and the testicle can get twisted around (testicular torsion). In this case there this condition can occur in infants and young children and it may be difficult to come to a diagnosis.
The anatomy of a normal spermatic cord is such that it contains the duct that transports sperm from the testicles, called “vas deferens” and the blood vessel bundle that supplies the structures with blood. When the spermatic cord is twisted as shown in this image here the vas deferens and affected testicle are swollen and very painful.
The patient experiences severe pain in the affected testicle, which can irradiate through nerve connections into the lower abdomen on the same side. There can be nausea and vomiting and there is usually local swelling of the scrotum overlying the testicle with torsion. Young children and infants may present only with a high fever and the physician would miss this condition, if the genitals are not also examined and palpated.
Treatment consists of a quick surgical exploration with testicle surgery where the testicle is repositioned and fixated to prevent a reoccurrence. Often the other side has to also be fixed at the same time to prevent testicular torsion on the other side in the near future.
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