Testicular appendage torsion

The testicular appendage is a pedunculated tissue on the white membrane of the testicle, which looks like a round polyp to the naked eye. Testicular appendage torsion is one of the common testicular emergencies. The initial onset of testicular appendage torsion is generally mild, but if it is acute, severe pain will occur. Testicular appendage torsion is often accompanied by symptoms such as nausea, vomiting, and fever. It is recommended to go to the hospital for treatment as soon as possible and undergo surgery if necessary.

The testicular appendages are the remnants of the upper end of the Mullerian duct. Located above the testicle, they are pedunculated oval bodies that are often attached to the white membrane of the testis. Torsion of the testicular appendages is more common in children. The appendages of the epididymis are the remnants of the Mullerian duct. There is often a history of vigorous exercise and scrotal injury, accompanied by severe nausea, vomiting, and severe scrotal pain. Doppler ultrasound examination shows no blood in the testicles. It is an acute inflammation of the epididymis, with an acute onset and may be accompanied by severe systemic symptoms, such as fever and increased white blood cell count. Generally, the history of unclean sexual intercourse and transurethral instrumental monitoring can be inquired.

Diagnosis/Testicular appendage torsion

Medical history

The onset is generally mild, gradually getting worse over a day or two; however, there are also cases where the pain is severe and the onset is acute.

Symptoms

Symptoms include sudden pain in the scrotum. It is usually dull pain, but can also be cramping pain. The degree of pain varies. The pain radiates to the lower abdomen. It may be accompanied by systemic symptoms such as nausea and vomiting.

Physical examination

A mass may be found above the testicle, with mild tenderness. A small amount of reactive hydrocele may be found. If necrosis occurs, the effusion may be blue in color when tested with transillumination, and the adnexa may be palpated above the testicle. The position of the testicle and spermatic cord is normal.

Differential diagnosis/testicular appendage torsion

The diseases that need to be distinguished from testicular appendage torsion are roughly the same as testicular torsion, and the following points should be paid attention to.

Testicular torsion

There is often a history of vigorous exercise and scrotal injury, accompanied by severe nausea, vomiting, and severe scrotal pain. During examination, the testicles may move upward, and moving the testicles may aggravate the pain. Doppler ultrasound examination shows no blood in the testicles.

Acute epididymitis

It is an acute inflammation of the epididymis. The disease is rapid and may be accompanied by severe systemic symptoms, such as fever and elevated white blood cell count. During examination, the scrotum is obviously enlarged and the skin is red. The epididymis is obviously enlarged and the boundary with the testicle is unclear. It is painful to touch. Generally, the patient can be asked about the history of unclean sexual intercourse and the history of transurethral instrument monitoring.

Treatment/Testicular appendage twistingEdit

(1) Symptoms can be relieved by supporting the scrotum, resting in bed, and taking oral non-hormonal anti-inflammatory drugs.

(2) When a clear diagnosis cannot be made, spermatic cord torsion should be excluded and surgical exploration should be performed if necessary.