Torsion of a Large Appendix Testis Misdiagnosed as Pyocele

Meher, Susanta; Rath, Satyajit; Sharma, Rakesh; Sasmal, Prakash Kumar; Mishra, Tushar Subhadarshan

doi:10.1155/2015/430871

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…1,6 The color Doppler sonography is the imaging technique most commonly used to differentiate between surgical (testicular torsion -without vascular flow) and non-surgical (epididymitis, testicular appendix torsion, appendix epididymis torsion, and orchiepididymitis) treatment. 4,5 Depending on the patient´s situation, conservative treatment can be performed, although surgery reduces the symptoms duration. 3…”

Section: Discussionmentioning

confidence: 99%

“…2 The appendix epididymis is visualized at ultrasound as a long-stalked structure projecting from the head of the epididymis and isoechoic to it, measuring 3 to 8 mm in adults. 1,2 The diseases related to the acute scrotum in children correspond to epididymitis or orchitis (31%), testicular torsion (38%), appendix testis torsion (24%) and torsion of the spermatic cord, 3,4 being a medical emergency due to the possibility of testicular torsion. 5 It occurs during the pre-pubertal years (ages…”

Section: Introductionmentioning

confidence: 99%

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Isolated torsion of appendix epididymis–a difficult diagnosis

Duarte¹,

Ribeiro²,

Scoppetta³

2020

UNOAJ

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An 8-year-old male patient complaining of pain in the left scrotum for four hours. Relatives deny comorbidities. The patient denies trauma or recent sports. On clinical examination, there is a small blue dot in the painful scrotum. Ultrasound shows preserved testicles, discarding testicular torsion, and a hypoechoic, oval, well-defined image, adjacent to the head of the left epididymis, measuring 6.5 mm, compatible with appendix epididymis torsion (Figure 1). The patient was conducted to conservative treatment-rest and analgesics, with resolution in one week.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Isolated torsion of appendix epididymis–a difficult diagnosis

Duarte¹,

Ribeiro²,

Scoppetta³

2020

UNOAJ

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“…(2019) устанавливал показания к удалению гидатиды только в случаях трудностей дифференциального диагноза с перекрутом яичка, расценивая состояние как склонное к спонтанному регрессу, в схему терапии им были включены постельный режим, холод к мошонке, возвышенное ее положение, нестероидные противовоспалительные препараты и анальгетики [22]. Meher S. (2015) так же прибегает к операции только в случаях невозможности исключения перекрута яичка и при длительном торпидном к терапии течении [23]. Krishnan A.…”

Section: результаты и обсуждениеunclassified

Nowadays treatment of testicular appendix torsion in children

Shedrov¹,

Grigoryeva

Shormanov

et al. 2020

Russian Journal of Pediatric Surgery

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Introduction. Currently, a modern tactics as to the treatment of testicular appendix torsion in children is not an indisputable axiom but it is a subject of discussion in domestic and foreign literature. Modern diagnostic tools, wide implementation of expert-class equipment as well as gaining more experience have reduced, to a minimum , the risk of diagnostic error with fatal consequences for the gonad. So, it impels to revise the existing algorithms and to consider the conservative treatment as the method of choice in uncomplicated testicular appendix torsion.Objective. To analyze the gained experience in treating testicular appendix torsion and to suggest reasonable algorithms which correspond to modern diagnostic techniques and treatment options. Material and methods. 2875 cases with testicular appendix torsion have been analyzed. Of these, 2 069 (71.96%) patients were operated on; 755 (26.26%) patients had conservative treatment and 51 (1.78%) had to be operated on despite conservative treatment.Results. The material obtained in three statistically homogeneous groups has been аnalyzed. When comparing clinical and ultrasound criteria, it was found out that the incidence of orchalgia in the surgical group is slightly higher than in the conservative one. It may indicate that the adhesive process in the scrotal cavity after surgical trauma is more frequent than after a possible aseptic inflammation. Asymmetry of gonad volumes with smaller diseased testicle was seen in all groups. The decrease in testicular volume is minimal in all cases and is not statistically significant. The incidence of heterogeneity in the testicular and appendage echo structure, which indicates sclerotic changes in the parenchyma, is also not statistically significant in the analyzed groups. Patients who were operated despite their conservative care do not have much worse outcomes after long-lasting follow-up period than groups with other curative options.Conclusion. Torsion of the testicular appendix in children is a challenging problem that is far from being solved. There is no consensus as to the indications for surgical treatment and to the assessment of postoperative outcomes. Modern diagnostic and monitoring techniques allow to dynamically monitor the scrotal organs in conservative treatment. The conservative treatment of testicular appendix torsion is an effective and safe method. The conservative tactics which was changed for surgical one does not lead to gonad deterioration.

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“…Ранее лечение данных пациентов сводилось к обязательному хирургическому вмешательству, но на протяжении последних 15 лет тактика ведения смещается в сторону использования консервативного лечения [4]. Связано это с повышением возможностей ультразвуковой диагностики на современном этапе и результатами лечения, позволяющими исключить необходимость Вестник урологии Vestnik Urologii 2023;11(4):120-127 вмешательства в остром периоде и избежать атрофии яичка в последующем [5,6,7]. Последние алгоритмы лечения, применяемые в детской практике, предлагают возможность консервативной тактики при неосложнённом течении заболевания и положительной динамике от начала консервативной терапии [8].…”

Section: Introductionunclassified

Testicular appendix (hydatid of Morgagni) torsion in adult urological management: evaluation of treatment outcomes

Shormanov,

Shedrov,

Garova

et al. 2023

Vestn. Urol.

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Introduction. Testicular appendix (hydatid of Morgagni) torsion (TAT) is relatively rare in patients over 18 years of age. To date, there are no systematised data on the long-term results of TAT treatment depending on the diagnostic and therapeutic tactics undertaken. Accordingly, there are no clear algorithms for the management of such patients.Objective. To evaluate and compare long-term results of various treatment options for patients with testicular appendix torsion over the age of 18 years.Materials & methods. The age of patients is from 18 to 46 years. We analysed the treatment results of TAT-patients in three comparison groups: those who received conservative treatment for uncomplicated course of the disease (group 1, n = 17), early surgical treatment for complicated course (group 2, n = 16), and patients who were operated on for complicated course if conservative therapy was ineffective (group 3, n = 17). The exclusion criteria were concomitant scrotal pathology (hydrocele, funicular hydrocele, varicocele, epididymitis); severe somatic pathology (diabetes mellitus, hypertension, heart attack, stroke). Evaluation of long-term results was carried out 9 – 12 months after the acute episode. Scrotal ultrasound (US) and Doppler US of testicular vessels were compared, endocrine status (levels of total testosterone, luteinising hormone, follicle-stimulating hormone) and reproductive function were studied based on the results of semen analysis and MAR-test.Results. Analyses of long-term clinical data revealed recurrent orchalgia in 29.4% of patients in group 3. Also, in group 3, US revealed testicular asymmetry in 47.1% of patients accompanied by hypotrophy of the affected testis up to 20.8% of the volume compared to the contralateral testis. There were no significant changes and differences in groups 1 and 2. Evaluation of endocrine function showed no significant difference of the studied groups from the control normative indicators. Semen analysis parameters were not significantly changed in groups 1 and 2. In group 3, asthenozoospermia was found in 23.5% of cases, and teratozoospermia was detected in 29.4% of patients.Conclusion. Conservative treatment for TAT without inflammatory changes does not lead to impaired spermatogenesis and structural changes of both the testis and its appendix in the long-term follow-up period and is the most accepted in practice. Early surgical intervention for inflammatory changes shows similar long-term results. Prolonged conservative treatment for TAT in secondary orchoepidididymitis with delayed surgery significantly worsens long-term results. This fact also demonstrates the need for early surgery in complicated TAT.

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Torsion of a Large Appendix Testis Misdiagnosed as Pyocele

Cited by 5 publications

References 7 publications

Isolated torsion of appendix epididymis–a difficult diagnosis

Isolated torsion of appendix epididymis–a difficult diagnosis

Nowadays treatment of testicular appendix torsion in children

Testicular appendix (hydatid of Morgagni) torsion in adult urological management: evaluation of treatment outcomes

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