Testes
Torsion of Testicular Appendage
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Torsion of Testicular Appendage
, Torsion of Appendix Testes
Epidemiology
Most common in boys under age 3-5 years up to age 12 years old
Pathophysiology
Appendix
Testicle
is a Mullerian Duct remnant on anterosuperior aspect of the
Testicle
Differential Diagnosis
Testicular Torsion
Epididymitis
Symptoms
Insidious or sudden onset of unilateral
Scrotal Pain
Less severe pain than with
Testicular Torsion
Similar characteristics of
Testicular Torsion
without the systemic symptoms (e.g. rare
Nausea
or
Vomiting
)
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
Differential Diagnosis
See
Testicular Torsion
See
Testicular Pain
Imaging
Scrotal Ultrasound
Diagnosis of Torsion of Testicular Appendage may be made clinically on exam
Critical to distinguish from
Testicular Torsion
in unclear cases
Ultrasound
demonstrates a low echogenic appendix (suggesting decreased
Blood Flow
)
Course
Pain resolves in 5-10 days (up to 14 days)
Precaution
May be difficult to distinguish from
Testicular Torsion
, especially in delayed presentation
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)
NSAID
s
References
Mace (2021) Crit Dec Emerg Med 35(9): 14-5
Lewis (1995) J Pediatr Surg 30:277-82 [PubMed]
Hawtrey (1998) Urol Clin North Am 25:715-23 [PubMed]
Ringdahl (2006) Am Fam Physician 74:1739-46 [PubMed]
Sharp (2013) Am Fam Physician 88(12): 835-40 [PubMed]
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