Testicular torsion, a time-dependent emergency, impacts young males, often leading to orchiectomy. Optimal salvage occurs within six hours, diminishing sharply thereafter. While manual detorsion is proposed, its use is restricted by patient discomfort, incomplete detorsion, and skill requirements. Our institution, encountering delayed presentations, has not employed this technique, underscoring the necessity for prompt intervention to improve outcomes.

A 20-year-old male presented with acute right testicular pain immediately sought consult at our emergency room 3 hours after onset. On physical examination, the right scrotum appeared erythematous, swollen and tender with a firm, high-riding testicle. On Ultrasound noted a twisted right spermatic cord which confirmed testicular torsion. Immediate manual detorsion was done and patient was subsequently admitted for scrotal exploration.

The patient underwent emergency scrotal exploration. Intraoperatively, both testes were viable, without hematoma or necrotic tissue. Orchiopexy with 3-point fixation was done bilaterally. The patient tolerated the procedure well and was subsequently discharged on the second postoperative day with an unremarkable course in the ward.

Testicular torsion, a time-sensitive urological emergency affecting mainly perinatal and pubertal males, results in testicular ischemia due to spermatic cord twisting. Prompt diagnosis and detorsion are crucial for testicular salvage. Physical examination reveals an erythematous, swollen, high-riding, and transversely oriented testis with absent cremasteric reflex and negative Phren's sign. Ultrasound confirms decreased or absent blood flow, with post-detorsion revealing restored flow. Manual detorsion, if successful allows for delayed orchiopexy. This case reports successful manual detorsion three hours post-torsion, followed by bilateral orchiopexy, highlighting the procedure's efficacy in minimizing ischemia and preserving testicular viability.