Intra-abdominal spermatic cord (testicular) torsion in a 4 month old dog

Wally is a 4 month old male entire Brittany Spaniel that presented to his regular veterinarian for peracute severe abdominal pain and vomiting. He was immediately referred to AEC Gold Coast for evaluation and treatment. Prior history was unremarkable, other than a right undescended testicle, with no trauma or dietary indiscretion that his owners were aware of.

On physical examination, Wally was trembling, depressed, and vocal with severe abdominal pain. His rectal temperature was 39.1oC, and his heart rate was 160bpm. Intravenous fluid therapy (Lactated Ringer’ solution) and methadone analgesia were administered. His abdominal pain was quite persistent despite analgesia. Further diagnostics included blood packed cell volume, total solids, serum electrolytes, venous blood gases and acid-base, lactate and urine specific gravity. Survey abdominal radiography and an abdominal ultrasound were also performed. The laboratory parameters evaluated were unremarkable.

Abdominal radiographs demonstrated a generalised small intestinal gas pattern consistent with ileus. No radiopaque foreign body or definitive obstructive pattern was noted.

Ultrasound evaluation revealed decreased small intestinal motility and an ovoid 1.4cm long-axis mass lesion in the right caudal abdomen, with an adjacent low volume anechoic effusion. No blood flow was detected in the structure on examination with colour-flow doppler.

Intra-abdominal testicular torsion was suspected and exploratory laparotomy was recommended. Surgery confirmed a torsed right spermatic cord and associated haematoma at the base of the torsion. The spermatic cord was carefully ligated with 3-0 polydioxanone (PDS) and the torsed testis and cord were resected. Closed castration of the descended scrotal testicle was performed routinely.

Post-operatively, Wally’s abdominal pain was much improved. The following morning he was discharged to his local veterinarian, where he spent the day prior to being discharged home. He recovered at home without complication.

Discussion

Spermatic cord (testicular) torsion is rare in the dog. Torsion can occur at any time during the normal descent from the abdomen to the scrotum. It is most commonly diagnosed in dogs with an intra-abdominal enlarged neoplastic testis. However, as in Wally’s case, torsion of a non-neoplastic intra-abdominal testis can also occur.

Dogs with torsion of an intra-abdominal testis usually have an acute onset of abdominal pain and restlessness. Lethargy, inappetance, vomiting, abdominal distension, ascites, fever and shock may also be seen depending on the duration of torsion. Differential diagnoses include other diseases that cause abdominal pain such as peritonitis, pancreatitis, splenic torsion or obstruction of the urinary or gastrointestinal tract.

Radiology is rarely diagnostic, but ultrasound evaluation is helpful in confirming the diagnosis prior to exploratory laparotomy. Sonographic findings include testicular enlargement with a uniform decrease in parenchymal echogenicity and concurrent enlargement of the epididymis and spermatic cord. Doppler ultrasound imaging may assist, but the presence of blood flow does not eliminate torsion as a possibility.

Orchiectomy is the treatment of choice as occlusion of venous drainage from the testis leads to subsequent testicular engorgement and necrosis. Complete castration at the same time is recommended as cryptorchidism is suspected to be a sex-linked autosomal recessive trait. Histopathology is recommended in cases of spermatic cord (testicular) torsion given the predisposition of abdominal testes to neoplasia, though was not performed in this case due to the normal gross appearance of the testis, the animal’s age and additional cost. The prognosis is good unless metastatic testicular neoplasia is present.

References

Feldman EC, Nelson RW. Disorders of the testes and epididymides. In: Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction 3rd ed. Saunders, St Louis, MO. 2004:pp 970-971.

Hecht S, King R, Tidwell AS, Gorman SC. Ultrasound diagnosis: intra-abdominal torsion of a non-neoplastic testicle in a cryptorchid dog. Vet Radiol Ultrasound 2004;45(1):58-61.

Boza S, de Membiela F, Navarro A, et al. What is Your Diagnosis? Testicular torsion. J Am Vet Med Assoc 2011;238:37-38.

Pearson H, Kelly DF. Testicular torsion in the dog: a review of 13 cases. Vet Rec 1975;97:200-204

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