MANAGEMENT OF SUSPECTED ANTENATAL TORSION - WHAT IS THE BEST STRATEGY

Currently, management of the newborn with suspected antenatal. torsion is somewhat controversial. Many surgeons recommend early surgical exp loration within the first few days of life, primarily to avoid errors in diagnosis. However, since the surgical and general anesthetic risks at this age are increased, it might be preferable to defer an operati on until risks to the patient are minimized. The optimal solution to t his dilemma would be the ability to diagnose torsion and exclude other conditions noninvasively. We present a series of 12 patients 1 to 14 days old who presented with a scrotal mass secondary to suspected ante natal testis torsion. Color Doppler ultrasound in each case demonstrat ed abnormal testicular blood flow and architecture consistent with tes tis torsion. Eventual exploration of all 12 patients confirmed prenata l torsion. We conclude that scrotal ultrasound with color Doppler enha ncement can accurately identify neonates with antenatal testis torsion and exclude other scrotal pathological conditions. If elected, surger y for torsion can then be deferred until the risks of anesthesia and s urgery are improved.