A 30-year-old male presents with sudden-onset left scrotal pain and a 'bell-clapper' deformity on ultrasound showing absent intratesticular blood flow. He is 6 hours from symptom onset. What is the Delorme's rule for salvage and what is the recommended operative approach?
- A < 6 hours = 90% salvage; immediate scrotal exploration and bilateral orchidopexy ✓
- B < 12 hours = 50% salvage; unilateral orchidopexy only
- C < 24 hours = 20% salvage; orchiectomy indicated if ischemic
- D Doppler USS must confirm torsion before operative exploration
Explanation
Testicular salvage rates in testicular torsion follow a time-dependent pattern: < 6 hours ≈ 90–100% salvage; 6–12 hours ≈ 50%; 12–24 hours ≈ 10%; >24 hours < 10%. Surgical exploration should not be delayed for imaging — clinical diagnosis mandates immediate scrotal exploration. If viable, 3-point fixation orchidopexy is performed (Dartos pouch or suture to scrotal wall). The contralateral testis must also undergo bilateral orchidopexy (3-point fixation) because the anatomical anomaly (bell-clapper deformity — high investment of tunica vaginalis) is bilateral in up to 40% of cases. Orchiectomy is performed if the testicle is non-viable after detorsion.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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