The most common underlying abnormality is the so-called bell clapper deformity which is the abnormally high attachment of the tunica vaginalis to the spermatic cord, allowing the testis and adjacent epididymis to move more freely, and thus places it at risk of twisting around the spermatic cord. In adolescents or young adults the more common torsion is intravaginal. In the neonatal form of torsion (extravaginal or supravaginal) the whole content of the hemiscrotum rotates around the spermatic cord at the level of the external inguinal ring 2,3. The TWIST score can be calculated to determine the need for ultrasound 8. Physical examination may reveal elevation of the affected testis, an absence of the cremasteric reflex, transverse lie of the testis, anterior rotation of epididymis, and pain relief with successful manual detorsion. Short periods of acute groin pain accompanied by vomiting and subsequent spontaneous relief may be typical patient history in these cases 5-7. This subentity has been increasingly reported in the literature. It is important to recognize that some patients may present with intermittent symptoms due to spontaneous detorsion, so-called intermittent testicular torsion. There should be no fever or urethral discharge. The onset of severe testicular pain is sudden and is not relieved by elevation of the scrotum 3. The hemiscrotum may be swollen or erythematous. In approximately 5-8% of cases, scrotal trauma is significant 1. The majority of cases of testicular torsion are either spontaneous or in the setting of minor/incidental trauma. typically occurs in adolescents and young adults.more common variety due to bell clapper deformity (see below).torsion occurs at the level of the external inguinal ring.Anatomically there are two types of testicular torsion which occur in different age groups 2,3: