Urology Book


Torsion of Testicular Appendage

Aka: Torsion of Testicular Appendage, Torsion of Appendix Testes
  1. Epidemiology
    1. Most common in boys under age 3-5 years up to age 12 years old
  2. Pathophysiology
    1. Appendix Testicle is a Mullerian Duct remnant on anterosuperior aspect of the Testicle
    2. Appendix Testicle is present in 85% of boys
  3. Differential Diagnosis
    1. Testicular Torsion
    2. Epididymitis
  4. Symptoms
    1. Insidious or sudden onset of unilateral Scrotal Pain
      1. Pain may be intense, but is typically less severe than with Testicular Torsion
    2. Similar characteristics of Testicular Torsion without the systemic symptoms (e.g. rare Nausea or Vomiting)
  5. Signs
    1. Tiny, focally tender, palpable mass at Testis upper pole
    2. "Blue dot" sign (gangrenous appendix Testicle) on scrotal skin early in course
    3. Testicular Inflammation and Hydrocele are late findings
      1. Testicle is typically not tender outside of focal tenderness at appendix Testicle
      2. Cremasteric Reflex is normal
    4. Reactive Hydrocele may be present
  6. Differential Diagnosis
    1. See Testicular Torsion
    2. See Testicular Pain
  7. Imaging
    1. Scrotal Ultrasound
      1. Diagnosis of Torsion of Testicular Appendage may be made clinically on exam (esp. with blue dot sign)
      2. Critical to distinguish from Testicular Torsion in unclear cases (do not miss Testicular Torsion)
      3. Ultrasound demonstrates a low echogenic appendix (suggesting decreased Blood Flow)
  8. Course
    1. Pain resolves in 5-10 days (up to 14 days)
  9. Precaution
    1. May be difficult to distinguish from Testicular Torsion, especially in delayed presentation
  10. Management
    1. Urology referral indications
      1. Presentation too late to make accurate diagnosis
      2. Unable to exclude Testicular Torsion
      3. Urologists may resect appendix Testes in cases of persistent discomfort
    2. Symptom management
      1. Scrotal support (e.g. tight underwear or jock strap)
      2. NSAIDs
  11. References
    1. Mace (2021) Crit Dec Emerg Med 35(9): 14-5
    2. Lewis (1995) J Pediatr Surg 30:277-82 [PubMed]
    3. Hawtrey (1998) Urol Clin North Am 25:715-23 [PubMed]
    4. Ringdahl (2006) Am Fam Physician 74:1739-46 [PubMed]
    5. Sharp (2013) Am Fam Physician 88(12): 835-40 [PubMed]

Torsion of appendix of testis (C0392531)

Concepts Anatomical Abnormality (T190) , Disease or Syndrome (T047)
ICD9 608.23
ICD10 N83.52, N44.03
SnomedCT 198047009
English Torsion of hydatid of Morgagni - male, Torsion hydatid Morgani - male, Torsion of hydatid of Morgani - male, Torsion of appendix of testis, torsion of appendix testis, torsion of appendix testis (diagnosis), testicle torsion appendix, Torsion appendix testis, Torsion of hydatid of Morgagni, Torsion of appendix testis, appendix testis torsion, torsion appendix testis, Torsion of appendix of testis (disorder), hydatid; Morgagni, torsion male, Hydatid of Morgagni torsion
Spanish torsión de apéndice testicular (trastorno), torsión de hidátide de Morgani en el hombre, torsión de apéndice testicular, torsión de hidátide de Morgani en el hombre (trastorno)
Dutch hydatide; Morgagni, torsie man
Derived from the NIH UMLS (Unified Medical Language System)

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