Hemorrhagic and ischemic necrosis of testes
The necrosis of the testes in this patient was due to untreated torsion of the spermatic cord, cutting off blood supply to testicular structures and leading to tissue death.
Torsion generally causes intense pain that can end up landing one in the ER, which leads to the majority of diagnoses in cases where there is no congenital predisposition to it. When surgically treated within 6 hours of onset, the testicle can be saved 90% of the time. Within 12 hours, the rate falls to around 50%, and by 24 hours of cut-off blood supply, the testicle can almost never be saved. The dead tissue must be removed when the testicle is not saved, or gangrene will set in.
Note in the photographs that though the tissue is clearly necrotic, it is not gangrenous. This patient received a prosthetic testicle and recovered with no complications.
