Testicular torsion after prior orchiopexy in an older adult: diagnostic pitfalls and the importance of multipoint fixation.

SummaryTesticular torsion is an uncommon cause of scrotal pain in adult men and is often associated with delayed diagnosis, prolonged time to intervention and high rates of orchiectomy. Recurrent torsion following orchiopexy is a rare and poorly characterised complication. We report a case of recurrent testicular torsion in a man in his 60s with a history of prior torsion with bilateral orchiopexy, as well as subsequent scrotal surgery. After the patient presented to the emergency department with acute scrotal pain on two separate occasions, recurrent torsion was ultimately identified. Successful testicular salvage was performed with a repeat three-point fixation orchiopexy. This case highlights the importance of maintaining suspicion for testicular torsion regardless of age or history of prior orchiopexy, the potential for scrotal surgery to disrupt prior fixation sutures and the need to confirm multipoint fixation during both initial orchiopexy and any subsequent scrotal reoperation.