Perinatal testicular torsion.

Case Report A 19-year-old mother of 2 gave birth to a 3892-g (8 lb, 11 oz) son. The pregnancy of 41 weeks and vaginal delivery were uncomplicated. The baby's Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. On initial examination in the newborn nursery, the infant's scrotum was noted to be purple, indurated, and enlarged to 3 em on the left side. The skin covering the left side of the scrotum was thickened and ecchymotic, and no testis could be recognized. A large hydrocele was noted on the right, but there were no inguinal hernias or other abnormalities. Bilateral fluid collections found later that day on ultrasonic examination suggested hydroceles, but no solid mass was seen on the left. The left side of the scrotum transilluminated poorly, while the right side transilluminated well. The following morning the left scrotal mass persisted, and needle aspiration of the mass yielded 3-mL dark reddish-black, serosanguinous fluid. No malignant cells were noted in the aspirated fluid. A urologist consulted at that time diagnosed testicular torsion. The infant's white cell count was 31 X 109/L (31,000 mm-3), and daily injections of 125-mg intramuscular ceftriaxone were ordered. The infant was taken to surgery the following morning, and a left inguinal incision showed extravaginal torsion of the spermatic cord. The spermatic cord was clamped because of the possibility of malignancy. A large hematocele and a necrotic left testicle were found, and the left testis