Haemoperitoneum and associated torsion of the testicle in the newborn
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A case of haemoperitoneum and concomitant torsion of the testes is reported - the first case in the English literature. The management of the case and the aetiological factors responsible for haemoperitoneum and torsion of the testes in the newborn are discussed. The role of vitamin K in the prevention of a possible subcapsular haematoma is discussed. At laparotomy approximately 80 ml of blood were aspirated from the peritoneal cavity. On the anterolateral aspect of the right lobe of the liver a 4 cm long tear (capsule and parenchyma) was discovered. Many abnormalities predispose towards torsion of the testis, the commonest of which is a horizontal position of the testes, but other factors which may contribute to the condition include a long mesorchium, broad flat chord and an unduly large tunica vaginalis. There are doubts whether torsion can occur in an anatomically normal testis. Although trauma is usually blamed for torsion of the testis, torsion can occur during sleep. Although haemoperitoneum in the newborn is always due to birth trauma, abnormalities in the blood clotting factors are important. There is a correlation between haemoperitoneum and breech extraction of the baby. In the case under discussion, trauma was probably produced by hyperextension, severe flexion or compression of the soft tissue structures against a hard bony prominence of the pelvic bones.
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