II. Epidemiology
- Most common in boys under age 3-5 years up to age 12 years old
III. Pathophysiology
IV. Differential Diagnosis
V. Symptoms
- Insidious or sudden onset of unilateral Scrotal Pain
- Pain may be intense, but is typically less severe than with Testicular Torsion
- Similar characteristics of Testicular Torsion without the systemic symptoms (e.g. rare Nausea or Vomiting)
VI. Signs
- Tiny, focally tender, palpable mass at Testis upper pole
- "Blue dot" sign (gangrenous appendix Testicle) on scrotal skin early in course
- Testicular Inflammation and Hydrocele are late findings
- Testicle is typically not tender outside of focal tenderness at appendix Testicle
- Cremasteric Reflex is normal
- Reactive Hydrocele may be present
VII. Differential Diagnosis
- See Testicular Torsion
- See Testicular Pain
VIII. Imaging
-
Scrotal Ultrasound
- Diagnosis of Torsion of Testicular Appendage may be made clinically on exam (esp. with blue dot sign)
- Critical to distinguish from Testicular Torsion in unclear cases (do not miss Testicular Torsion)
- Ultrasound demonstrates a low echogenic appendix (suggesting decreased Blood Flow)
IX. Course
- Pain resolves in 5-10 days (up to 14 days)
X. Precaution
- May be difficult to distinguish from Testicular Torsion, especially in delayed presentation
XI. Management
- Urology referral indications
- Presentation too late to make accurate diagnosis
- Unable to exclude Testicular Torsion
- Urologists may resect appendix Testes in cases of persistent discomfort
- Symptom management
- Scrotal support (e.g. tight underwear or jock strap)
- NSAIDs