Bell Clapper Deformity Of The Testes: Causes and Treatment

Diagram showing normal testicle vs bell clapper deformity

Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org. From the case rID: 86124

What Is Bell Clapper Deformity?

Bell clapper deformity is a condition where the testes are positioned horizontally in the scrotum, rather than being aligned vertically. This allows the testicle to rotate freely and increases the chances for testicular torsion occurring.

Bell clapper deformity is a congenital abnormality that typically affects both testicles. It occurs in less than 1% of all males.

Cause

Bell clapper deformity is caused by a birth defect in which the spermatic cord leading to the testicle is attached at an unusually high angle to the membrane surrounding the testes (tunica vaginalis).

Because of the higher location of attachment, the testicle is able to rotate freely in the scrotum, increasing the likelihood of developing testicular torsion.

Testicular torsion refers to a condition in which the the spermatic cord becomes twisted, cutting off the blood supply to the testicle. If this occurs, emergency surgery is usually required to prevent the testicle from dying and being removed.

Diagram of testicle with bell clapper deformity with testicular torsion.

Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org. From the case rID: 86124

Symptoms

Bell clapper testes don’t generally cause symptoms unless the spermatic cord becomes twisted, cutting off the blood supply to the testis (testicular torsion). Sometimes they may be detected during an examination for an unrelated reason.

It is possible for the condition to cause occasional pain in one or both testicles due to the testicle twisting and untwisting on periodically. If you experience any sudden pain in your scrotum, it is extremely important that you seek medical attention as soon as possible.

Treatment

A clinical examination is used to identify and diagnose bell clapper testes. It is necessary for the patient to stand during the examination, otherwise the deformity can go undetected.

Once identified, bell clapper deformity may be treated with an operation known as a scrotal orchiopexy. An orchiopexy is an outpatient procedure that takes place in the hospital and requires general anesthesia.

This operation involves permanently fixing the testes in the scrotum to prevent them from rotating. It is performed on an outpatient basis under general anesthesia, and you will usually be able to return home the same day.

The doctor will typically use stitches that don’t require removal and will dissolve gradually within 2-3 weeks. During the first few days you may experience fluid seeping from the incision site. This is normal. You will also likely experience some swelling, which should subside within 2-4 weeks.

It is also possible that you experience some mild to moderate pain for several days following the procedure. Your doctor will advise you about what type of pain reliever or any prescription pain medication you may need to take.

After one or two weeks, you should be able to resume most of your usual activities, with the exception those requiring much physical exertion. You should avoid straining your bowel movements and heavy lifting during your recovery time.

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