Neonatal Testicular Torsion Associated with Neonatal Stress: A Case Report

Introduction: Neonatal testicular torsion (NTT) is a rare but critical condition requiring prompt diagnosis and intervention to prevent testicular loss. Though rare, it accounts for greater than ten percent of testicular torsion cases in the pediatric population. Case Presentation: A 4-day old, ex-36-week gestational age, male infant was admitted to the neonatal intensive care unit (NICU) for hyperbilirubinemia and choking episodes at home. He was the product of a difficult vaginal delivery associated with clavicular fracture. On day two of admission, a firm left testicle and a right hydrocele were noted. There were no signs of distress, tenderness to palpation, nor scrotal color change during the exam. An ultrasound revealed diminished blood flow to the left testicle with morphology suggestive of NTT and a large right hydrocele. The infant was taken to the operating room where left testicular torsion was confirmed; a necrotic left testicle was unsalvageable. Pathology revealed hemorrhagic necrosis without malignancy. Conclusion: Testicular torsion in the newborn period is rare and often difficult to diagnose as there are varying clinical presentations and the infant does not display signs of distress. It has been postulated that fetal stress during pregnancy or delivery is a predisposing factor for NTT; however, little research has been done on whether postpartum stress can contribute to NTT. This case highlights a neonate with testicular torsion discovered following both a stressful delivery and choking event at home. It underscores the importance of considering NTT in neonates with abnormal testicular exam findings, particularly those with stressful deliveries and/or clinical histories.