II. Epidemiology

  1. Most common in boys under age 3-5 years up to age 12 years old

III. Pathophysiology

  1. Appendix Testicle is a Mullerian Duct remnant on anterosuperior aspect of the Testicle

IV. Differential Diagnosis

V. 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)

VI. 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

VII. Differential Diagnosis

VIII. Imaging

  1. Scrotal Ultrasound
    1. Diagnosis of Torsion of Testicular Appendage may be made clinically on exam
    2. Critical to distinguish from Testicular Torsion in unclear cases
    3. Ultrasound demonstrates a low echogenic appendix (suggesting decreased Blood Flow)

IX. Course

  1. Pain resolves in 5-10 days (up to 14 days)

X. Precaution

  1. May be difficult to distinguish from Testicular Torsion, especially in delayed presentation

XI. 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

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Ontology: 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