The spermatic cord begins in the deep inguinal ring, exits the superficial inguinal ring, and enters the scrotum. The contents of the spermatic cord are numerous and include: the vas deferens (a duct from the epididymis to the urethra to deliver sperm), the testicular artery, artery to the vas deferens, the cremasteric artery and muscle, the pampiniform plexus (venous plexus), a branch of the genitofemoral nerve and autonomic fibers, lymphatics. Testicular torsion occurs when the cord is twisted, thus cutting off the blood supply to the testis. Torsion usually occurs in early childhood and preadolescence. It is rare in men older than 30. Symptoms include acute onset of testicular pain, nausea, vomiting, and abdominal pain. The testes will be elevated on the affected side due to shortening of the twisted spermatic cord. There will be an absence of the cremasteric reflex due to strangulation of the cremasteric artery and muscle. Instead of riding diagonally, the ischemic testis will display the Bell-Clapper deformity, and transverse or horizontal lie with the scrotum. Correction of the torsion results in a salvage rate of 90% if done within 6 hours. If greater than 48 hours, the testes can usually not be saved, thus time is critical. Doppler ultrasound is the test of choice, but if suspicion is high, proceed directly to urgent Urology consultation. Manual untwisting of the affected testes can be attempted to unwrap the cord if help is not available. Torsion occurs 2/3 of the time twisted medially, so first attempt should be from a medial to a lateral direction for @ two twists. If no affect, can attempt in the other direction, lateral to medial. Success is suggested by a testes that descends and with relief of pain. The relief may be temporary as torsion can recur.