Intermittent torsion: Association with horizontal lie of the testicle

The importance of making an early diagnosis of intermittent testicular torsion cannot be over-emphasized. We report on 3 patients with recurrent episodes of severe testicular pain but who were pain-free at evaluation. All 3 patients were found to have a horizontal lie of the symptomatic testicle and a normal vertical axis in the contralateral asymptomatic testicle. Scrotal exploration revealed a bell-clapper deformity in all 3 patients. A history of recurrent scrotal pain and horizontal testicular lie, even in the absence of pain at the time of physical examination, is a strong indication for exploration and bilateral testicular fixation.