| Peer-Reviewed

Torsion of the Testicular Appendages in Adult Acute Scrotum

Received: 28 August 2019     Accepted: 15 October 2019     Published: 26 October 2019
Views:       Downloads:
Abstract

Adult patients with acute scrotum sometimes tend to be treated for epididymitis without undergoing ultrasonographic examination, although precise ultrasonography reveals that there are some patients with torsion of the testicular appendages. In this report, I investigate the incidence of patients with torsion of the testicular appendages among patients with adult acute scrotum, who mainly used to be treated for epididymitis. In the last 5 years, 46 patients (23~62, average age 43.5 years) with scrotal pain and swelling visited our clinic for diagnosis and treatment. On an outpatient basis, their symptoms were evaluated, and blood tests, urinalysis, and grey scale and color Doppler ultrasonography with a 5-12 MHz linear scan were performed. Five (10.9%) of the 46 patients were diagnosed as having torsion of the testicular appendages. Although none of them had a high fever, 4 of the 5 (80%) had nausea and abdominal pain. Leukocytosis and pyuria were not found in any case. Typical ultrasound appearances were reactive hydrocele and a hyperechoic swollen mass or enlarged hyperechoic, spherical mass of the appendage. On color Doppler ultrasonography, there was no blood flow within the torsed appendage testis, and an increase in periappendiceal blood flow was seen in all of the cases. They were treated conservatively with anti-inflammatory agents and cooling, and their symptoms disappeared within 2 weeks. It is suggested that as many as 10.9% of adult patients with scrotal pain and swelling may suffer from torsion of the testicular appendages. We should conduct ultrasonography for adult patients with acute scrotum.

Published in International Journal of Clinical Urology (Volume 3, Issue 2)
DOI 10.11648/j.ijcu.20190302.13
Page(s) 40-45
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Torsion of the Testicular Appendages, Appendix Testis, Appendix Epididymitis, Acute Scrotum

References
[1] McAndrew HF, Pemberton R, Kikiras CS (2002). The incidence and investigation of acute scrotal problems in children. Pediatric Surgery Internationalis 1, 435-437.
[2] Mushtaq I, Fung M, Glasson MJ (2003). Retrospective review of pediatric patients with acute scrotum. ANZ Journal of Surgery 73, 55-59.
[3] Skoglund RW, McRoberts JW, Ragde H (1970). Torsion of testicular appendages: presentation of 43 new cases and a collective review. Journal of Urology 104, 598-600.
[4] Ruiz Montes AM, Jimenez AC, Nunez NR (1994). The clinical characteristics of patients with torsion of the testicular and epididymal appendages. Cirgia Pediatrica 7, 140-142.
[5] Pomajizi AJ, Leslie SW (2019). Appendix testis torsion. Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing.
[6] Park SJ, Kim HL, Yi BH. (2011). Sonography of intrascrotal appendage torsion: varying echogenicity of the torsed appendage according to time from onset. Journal of Ultraound of Medicine. 30 (10), 1391-1396.
[7] Lewis AG, Bukowski TP, Jarvis PD (1995). Evaluation of acute scrotum in the emergency department. Journal of Pediatric Surgery 30:, 272-282.
[8] Mufti RA, Ogedegbe AK, Lafferty K (1995). The use of Doppler ultrasound in the clinical management of acute testicular pain. British Journal of Urology 76, 625-627.
[9] Watkin NA, Reiger NA, Moisey CU (1996). Is the conservative management of the acute scrotum justified on clinical grounds. British Journal of Urology 78, 623-627.
[10] Kass EJ, Lundak B (1997). The acute scrotum. Pediatric Urology 44, 1251-1266.
[11] Karmazyn B, Sternberg R, Kornreich L (2005). Clinical and sonographic criteria of acute scrotum in children. Pediatric Radiology 35, 302-310.
[12] Kim JS, Shin YS, Park JK. (2018). Clinical features of acute scrotum in children and adolescence: Based on 17 years experiences in primary care clinic. American Journal of Emergent Medicine. 36 (7), 1302-1303.
[13] Fujita N, Tambo M, Okegawa T, Higashihara E, Nutahara K. (2017). Distinguishing testicular torsion from torsion of the appendix testis by clinical features and sign in patients with acute scrotum. Research representave Urology 9, 164-174.
[14] Burgher SW (1998). Acute scrotal pain. Emergency Medical Clinics of North America 4, 781-809.
[15] Kadish HA, Bolte RG (1998). A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics 102, 73-76.
[16] Chia-Chu Liu, Shu-Pin Huang, Yii-Her Chou, Ching-Chia Li, Ming-Tsang Wu, Chun-Hsiung Huang, Wen-Jeng Wu (2007). Clinical presentation of acute scrotum in young males. Kaohsiung Journal of Medical Science 23 (6), 281-285.
[17] Lyronis ID, Ploumis N, Vlahakis I, Charissis G. (2009). Acute scrotum –etiology, clinical presentation and seasonal variation. Indian Journal of Pediatrics. 76 (4), 407-410.
[18] Sellars M E and Sidhu P S (2003). Ultrasound appearances of the testicular appendages: pictorial review. European Radiology 13, 127-135.
[19] Hesser U, Rosenborg M, Gierup J (1993). Grey scale sonography in torsion of the testicular appendages. Pediatric Radiology 23, 529-532.
[20] Strauss S, Faingold R, Manor H (1997). Torsion of the testicular appendages: sonographic appearance. Journal of Ultrasound and Medicine 16, 189-192.
[21] Cohen H L, Shapiro M A, Haller J O (1992). Torsion of the testicular appendage: sonographic diagnosis. Journal of Ultrasound and Medicine 11, 81-83.
[22] Johnson K A and Dewbury K C (1996). Ultrasound imaging of the appendix testis and appendix epididymis. Clinical Radiology 51, 335-337.
[23] Rolnick D, Kawanoue S, Szanto P (1968). Anatomical incidence of testicular appendages. Journal of Urology 100, 755-756.
[24] Dogra V S, Gottlieb R H, Oka M (2003). Sonography of the scrotum. Radiology 227, 18-36.
[25] Ivens U (1972). Morphology and function of the appendix testis. Andrologie 4, 245-258.
[26] Jacob M, Barteczko K (2005). Contribution to the origin and development of the appendices of the testis and epididymis in human. Anatomical Embryology 209, 287-302.
[27] Yang D M, Lim J W, Kim J E (2005). Torsed appendix testis. Journal of Ultrasound and Medicine 24, 87-91.
[28] Rakha E, Puls F, Saidul I and Furness P (2006). Torsion of the testicular appendix: importance of associated acute inflammation. Journal of Clinical Pathology 59, 831-834.
Cite This Article
  • APA Style

    Seiichi Saito. (2019). Torsion of the Testicular Appendages in Adult Acute Scrotum. International Journal of Clinical Urology, 3(2), 40-45. https://doi.org/10.11648/j.ijcu.20190302.13

    Copy | Download

    ACS Style

    Seiichi Saito. Torsion of the Testicular Appendages in Adult Acute Scrotum. Int. J. Clin. Urol. 2019, 3(2), 40-45. doi: 10.11648/j.ijcu.20190302.13

    Copy | Download

    AMA Style

    Seiichi Saito. Torsion of the Testicular Appendages in Adult Acute Scrotum. Int J Clin Urol. 2019;3(2):40-45. doi: 10.11648/j.ijcu.20190302.13

    Copy | Download

  • @article{10.11648/j.ijcu.20190302.13,
      author = {Seiichi Saito},
      title = {Torsion of the Testicular Appendages in Adult Acute Scrotum},
      journal = {International Journal of Clinical Urology},
      volume = {3},
      number = {2},
      pages = {40-45},
      doi = {10.11648/j.ijcu.20190302.13},
      url = {https://doi.org/10.11648/j.ijcu.20190302.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20190302.13},
      abstract = {Adult patients with acute scrotum sometimes tend to be treated for epididymitis without undergoing ultrasonographic examination, although precise ultrasonography reveals that there are some patients with torsion of the testicular appendages. In this report, I investigate the incidence of patients with torsion of the testicular appendages among patients with adult acute scrotum, who mainly used to be treated for epididymitis. In the last 5 years, 46 patients (23~62, average age 43.5 years) with scrotal pain and swelling visited our clinic for diagnosis and treatment. On an outpatient basis, their symptoms were evaluated, and blood tests, urinalysis, and grey scale and color Doppler ultrasonography with a 5-12 MHz linear scan were performed. Five (10.9%) of the 46 patients were diagnosed as having torsion of the testicular appendages. Although none of them had a high fever, 4 of the 5 (80%) had nausea and abdominal pain. Leukocytosis and pyuria were not found in any case. Typical ultrasound appearances were reactive hydrocele and a hyperechoic swollen mass or enlarged hyperechoic, spherical mass of the appendage. On color Doppler ultrasonography, there was no blood flow within the torsed appendage testis, and an increase in periappendiceal blood flow was seen in all of the cases. They were treated conservatively with anti-inflammatory agents and cooling, and their symptoms disappeared within 2 weeks. It is suggested that as many as 10.9% of adult patients with scrotal pain and swelling may suffer from torsion of the testicular appendages. We should conduct ultrasonography for adult patients with acute scrotum.},
     year = {2019}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Torsion of the Testicular Appendages in Adult Acute Scrotum
    AU  - Seiichi Saito
    Y1  - 2019/10/26
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ijcu.20190302.13
    DO  - 10.11648/j.ijcu.20190302.13
    T2  - International Journal of Clinical Urology
    JF  - International Journal of Clinical Urology
    JO  - International Journal of Clinical Urology
    SP  - 40
    EP  - 45
    PB  - Science Publishing Group
    SN  - 2640-1355
    UR  - https://doi.org/10.11648/j.ijcu.20190302.13
    AB  - Adult patients with acute scrotum sometimes tend to be treated for epididymitis without undergoing ultrasonographic examination, although precise ultrasonography reveals that there are some patients with torsion of the testicular appendages. In this report, I investigate the incidence of patients with torsion of the testicular appendages among patients with adult acute scrotum, who mainly used to be treated for epididymitis. In the last 5 years, 46 patients (23~62, average age 43.5 years) with scrotal pain and swelling visited our clinic for diagnosis and treatment. On an outpatient basis, their symptoms were evaluated, and blood tests, urinalysis, and grey scale and color Doppler ultrasonography with a 5-12 MHz linear scan were performed. Five (10.9%) of the 46 patients were diagnosed as having torsion of the testicular appendages. Although none of them had a high fever, 4 of the 5 (80%) had nausea and abdominal pain. Leukocytosis and pyuria were not found in any case. Typical ultrasound appearances were reactive hydrocele and a hyperechoic swollen mass or enlarged hyperechoic, spherical mass of the appendage. On color Doppler ultrasonography, there was no blood flow within the torsed appendage testis, and an increase in periappendiceal blood flow was seen in all of the cases. They were treated conservatively with anti-inflammatory agents and cooling, and their symptoms disappeared within 2 weeks. It is suggested that as many as 10.9% of adult patients with scrotal pain and swelling may suffer from torsion of the testicular appendages. We should conduct ultrasonography for adult patients with acute scrotum.
    VL  - 3
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Art Park Urology Hospital & Clinic, Sapporo, Japan

  • Sections