Introduction: Up to 22% of pediatric patients with testicular torsion (TT) present initially with lower abdominal pain, which progresses to scrotal pain over time. Misdiagnosis can lead to testicular loss. This study examines the frequency of this presentation in adults and its clinical implications. Materials and Methods: We retrospectively analyzed 92 adult patients diagnosed with TT at our Emergency Departments (EDs). Clinical presentations, diagnostic procedures, and outcomes were reviewed, focusing on cases with abdominal pain as the initial symptom. Results: Seven of 92 patients (6.44%) presented with abdominal pain alone. Testicular viability was preserved in three cases, highlighting the importance of early recognition, of those: two had early testicular pain (< 6 h) which prompted surgery; the third had TT discovered during urologic consultation requested because of recent history of testicular pain, even if no scrotal symptoms were present at that moment. In four cases, delayed diagnosis led to testicular necrosis. Three had late (> 7 h) development of testicular pain; the fourth had testicular pain at < 6 h but, a false negative US examination misinterpreted as epididymitis. Conclusion: Although this study is retrospective and reconstructing the exact onset of symptoms is difficult and this may lead to potential bias; the study identifies abdominal pain as a rare but clinically significant first symptom of TT in adults. TT should be considered in differential diagnosis of all adults with lower abdominal pain and testes should be always assessed during physical examination of any male with such symptoms.
