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Torsion of Testicular Appendage – Hydatid Torsion

Definition

Torsion of Testicular Appendage is the rotation of the testicular appendix (hydatid of Morgagni) around its pedicle, leading to hemorrhagic necrosis.

Signs and Symptoms of Hydatid Torsion

• Testicular pain
• Edema of the scrotum
• Blue dot sign: the hemorrhagic infarcted appendix testis is visible through the scrotum

Diagnostic Workup

Imaging

Doppler ultrasonography of the testis: signs for torsion of testicular appendage are a mild hydrocele and an enlarged testicular appendix [fig. ultrasonography of hydatid torsion ] and evidence of testicular blood flow. The reliable differentiation between testicular torsion and torsion of the testicular appendage can be difficult; surgical exploration may be necessary.

Ultrasonography of hydatid torsion: with hydrocele and a visible testicular appendix. With kind permission, Prof. Dr. R. Harzmann, Augsburg.

Treatment of Hydatid torsion

In principle, the torsion of testicular appendage is treated conservatively with analgesics. In the case of surgical exploration, the testicular appendage is removed after coagulation of the basis.

References

C. Radmayr, G. Bogaert, H. S. Dogan, and S. Tekgül, “EAU Guidelines: Paediatric Urology.” [Online]. Available: https://uroweb.org/guidelines/paediatric-urology/

  Deutsche Version: Hydatidentorsion