Left: Testicular torsion and hemorrhage. Testicle removed from abdomen after causing significant pain. Patient maintained one testicle (the one that descended after birth).
Right: Normal testicle, epididymis, and spermatic cord.
Testicular torsion is usually caused by something called a “bell-clapper” deformity, where the testicle is inadequately secured to the scrotum, and can move freely enough to tangle up the testicular cords. If it’s caught early (within 6 hours from the onset of pain), the damage is usually reversible, and during the procedure to untangle the cords, the testicle that became twisted can be secured to the scrotum, so that this does not recur.
However, if the pain is ignored or not treated, irreversible ischemia of the tissues begins to set in around the 6-hour mark, and is usually seen as completely irreversible (meaning castration of the testicle is called for) after 24-48 hours.
A Text-Book of Genito-Urinary Diseases, including Functional Sexual Disorders in Men. Dr. Leopold Casper, translated by Charles Bonney, 1907,