Appendages of the testis (Figure 53.17, page 2581, Kogan et al):
(1) appendix testis (hydatid of Morgagni)
(2) appendix epididymis
(3) superior and inferior vas aberrans of Haller
(4) paradidymis (organ of Giraldes)
An appendage that is long and pedunculated is more likely to undergo torsion.
Many patients are prepubertal, with a peak incidence at 10 years of age.
Clinical findings:
(1) scrotal pain
(2) the patient may describe previous episodes that resolved spontaneously
(3) nausea, vomiting and diaphoresis may be present
(4) blue dot sign (appendage visualized through scrotal skin)
(5) palpable swelling at the upper or lower pole of the testis
(6) the adjacent testis is palpably normal
(7) the patient is able to walk to the doctor to seek advice (Hamilton Bailey)
Ultrasonography may be helpful to confirm the physical findings and the presence of blood flow to the testis.
Scrotal exploration may be performed if there is doubt in the diagnosis or if the physical examination is obscured by a hydrocele or other comorbid condition.
The patient can be managed conservatively with analgesics. The torsed appendage will typically infarct and be resorbed. The patient should be followed to make sure that the patient follows the expected course.
