Testicular torsion in Ethiopia: a case series and systematic review of the sub-Saharan African literature

Background: We report on the presentation, clinical course and outcome of patients with testicular torsion in Addis Ababa, Ethiopia to identify opportunities for improved care.
Methods: A retrospective review of clinical records of patients with testicular torsion presenting to a hospital with pediatric surgical expertise in Addis Ababa, Ethiopia in 2012- 4 was performed and analyzed descriptively. A systematic review of published literature about testicular torsion in sub-Saharan Africa between 1990-2014 was performed using the PubMed and African Journals Online databases.
Results: Seven patients aged 5 days to 18 years were diagnosed with testicular torsion, six with acute symptoms and one with chronic, intermittent symptoms. The most common symptoms were scrotal swelling and unilateral pain. In 4/6 acute cases, surgical consultation was delayed to obtain color Doppler ultrasound. In 5/6 cases, including all in which ultrasound was obtained, the testis was nonviable, requiring orchiectomy. Thirteen studies reported on testicular torsion in sub-Saharan Africa in the past 25 years.
Conclusions: Testicular torsion remains an under-appreciated surgical emergency in Ethiopia. Delays in presentation and diagnosis contribute to high levels of testicular loss. A high index of suspicion is warranted, and surgical consultation should not be delayed to obtain ultrasound confirmation in this setting.