Testes

Torsion of Testicular Appendage

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Torsion of Testicular Appendage, Torsion of Appendix Testes

  • Epidemiology
  1. Most common in boys under age 3-5 years up to age 12 years old
  • Differential Diagnosis
  1. Testicular Torsion
  2. Epididymitis
  • Symptoms
  1. Insidious or sudden onset of unilateral Scrotal Pain
    1. Less severe pain than with Testicular Torsion
  2. Similar characteristics of Testicular Torsion without the systemic symptoms (e.g. rare Nausea or Vomiting)
  • Signs
  1. Tiny, focally tender, palpable mass at Testis upper pole
  2. "Blue dot" sign on scrotal skin early in course
  3. Testicular Inflammation and Hydrocele are late findings
  • Differential Diagnosis
  1. See Testicular Torsion
  2. See Testicular Pain
  • Imaging
  1. Ultrasound
    1. Critical to distinguish from Testicular Torsion
  • Course
  1. Pain resolves in 5-10 days (up to 14 days)
  • Precaution
  1. Difficult to distinguish from Testicular Torsion
  • Management
  1. Urology referral indications
    1. Presentation too late to make accurate diagnosis
    2. Unable to rule-out Testicular Torsion
    3. Urologists may resect appendix Testes in cases of persistent discomfort
  2. Scrotal support (e.g. tight underwear or jock strap)
  3. NSAIDs
  • References
  1. Lewis (1995) J Pediatr Surg 30:277-82 [PubMed]
  2. Hawtrey (1998) Urol Clin North Am 25:715-23 [PubMed]
  3. Ringdahl (2006) Am Fam Physician 74:1739-46 [PubMed]
  4. Sharp (2013) Am Fam Physician 88(12): 835-40 [PubMed]