History
A 3 y.o. Show Jumper stallion was referred with a diagnosis of scrotal hernia. The horse was found with signs of colic in the morning and the left testis appeared enlarged and painful at palpation, surrounded by a thick and edematous scrotum.
Diagnosis and surgical management
At admission, the horse appeared depressed but not particularly painful unless the left side of the scrotum was palpated. A thick edema could be appreciated in this area and the horse reacted to palpation. The blood tests were nearly normal: PCV 34%, Total Plasma Proteins 7,2 g/dl, WBC 10.700/mm3, blood lactate 0,9 mml/l. Differential diagnoses included scrotal hernia or so called “testicular torsion”.
The horse was operated in dorsal recumbency under general anesthesia maintained with isofluorane vaporized by oxygen and nitrous oxide after premedication with xylazine and induction with guaifenesin and ketamine.
After incision in the inguinal area, the subcutaneous tissue appeared edematous and the scrotum, inspissated to over 2 cm. The testis was then exposed and the vaginal tunic showed a dark, nearly black content that, after penetration of the tunic, appeared to be a necrotic testis with a complete torsion of the spermatic cord (Fig. 1). No intestinal hernia was present. The testis was removed after routine emasculation and ligation of the proximal segment of the funicle. The contralateral testis was removed as well.
Fig. 1
The horse made uneventful recovery and during the following days showed good attitude, appetite and absence of pain. It was dismissed after 4 days and one month later the owner reported that the horse was back in training.
Comments
Torsion of the spermatic cord, commonly referred as testicular torsion, is a condition occurring when the attached testis rotates on its vertical axis. Torsion of the spermatic cord causes the testicular vessel to twist, producing venous and often arterial obstruction with complete testicular infarction, like in the case described here. The condition has nothing to do with the 180 degrees rotation which is a relatively frequent finding in normal, asymptomatic horses.
The main differential diagnosis is strangulated inguinal or scrotal hernia, in which there is involvement of ileum or jejunum. In cases of torsion, the pain is less compared to hernia and the situation appears to be less dramatic. In any case, the devitalized testis needs to be quickly removed to avoid further complications. The prognosis for survival is good.