Painful Swelling (Differential Diagnosis as before)

swel_21a_n.jpg and swel_21b_n.jpg: Operative findings in a toddler with a painful groin swelling of the left side since more than 24 hours ago. Figure swel_21a_n.jpg: After an inguinal skin incision a dark red to black mass becomes visible. Figure swel_21b_n.jpg: After preparation of the vessels of the spermatic cord and of the vas deferens the color of the mass remains the same. The further preparation serves to exclude a sac of an inguinal hernia and to lengthen the spermatic vessels and the vas deferens. No inflammatory skin reaction caused by the ongoing process is visible. Figure swel_21a_n.jpg and swel_21b_n.jpg: The diagnosis is a testicular torsion in a left-sided cryptorchidism. Testis and epididymis are irrevocably injured; the finger of the surgeon points to the testis, above the testis lies the epididymis. In cryptorchidism testicular torsions occur more frequently than in testicles with regular site. This fact explains why a testicular torsion in cryptorchidism may be a differential diagnosis of an incarcerated inguinal hernia. In contrast to the demonstrated case, the testis lies in case of a normally descended testis in the scrotum. It is possible that the testicle is clinically less delimited in inguinoscrotal hernia. In premature infants and neonates at term with frequent cryptorchidism the high position of the testis may be an important differential diagnosis of an irreponible or incarcerated inguinal hernia even if there is no testicular torsion.