Spermatic Cord Rotation and Torsion
Basic Information 
Definition
• Rotation describes twisting of the spermatic cord along the longitudinal axis, usually 180 degrees or less, and is generally an incidental finding.
• Torsion is an acute clinical condition in which the spermatic cord rotates at least 180 degrees, usually 360 to 720 degrees, compromising blood supply to the testis.
Clinical Presentation
History, Chief Complaint
• Spermatic cord rotation, often an incidental finding, may be chronic or intermittent, with the owner relating an abnormal contour to the testis. There is generally no history of pain associated with rotation, but compromise of blood supply by as much as 40% may occur. However, fertility appears to be unaffected.
• In stallions with acute spermatic cord torsion, clinical signs include unilateral scrotal or testicular enlargement (or both), inguinal pain, colic, and a stilted hindlimb gait.
• Occasionally, cases of chronic, recurring spermatic cord torsion are presented with periodic discomfort referable to the inguinal region, abdomen, scrotum, or hindquarters.
Physical Exam Findings
Etiology and Pathophysiology
• Definitive causes of spermatic cord torsion have not been elucidated. However, several predisposing factors have been suggested as being permissive for rotation of the spermatic cord, including an excessively long ligament of the tail of the epididymis, proper ligament of the testis, and mesorchium.
• Twisting of the spermatic cord around its longitudinal axis and rotation of the testis about its vertical axis result in compromised blood flow to the scrotal contents through the testicular artery and outflow via the pampiniform plexus. Lymphatic drainage is also interrupted.
• Obstruction of the pampiniform plexus results in hemorrhage and edema within the testicular parenchyma, exerting pressure on the relatively inelastic tunica albuginea and causing pain. Edema and hemorrhage may also develop in the spermatic cord and scrotum.
• Peritoneal fluid may accumulate in the vaginal cavity, resulting in a hydrocele.
• Intra- and extratesticular hemorrhage and edema, inflammation, and hydrocele formation increase the intrascrotal temperature. Scrotal insulation predisposes the affected and contralateral testes to thermally induced degeneration.
• Occlusion of the testicular artery results in ischemia of the affected testis, epididymis, and scrotal skin. Prolonged spermatic cord torsion results in ischemic necrosis and irreversible damage to the testicular parenchyma.
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