Torsion of the Testicular Appendages in Adult Acute Scrotum

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.

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

“…Чаще всего авторы, описывающие состояния, связанные с поражением гидатиды у пациентов старше 18 лет, приводят единичные клинические случаи [9 -11]. Однако S. Saito (2019) отмечал наличие перекрута гидатиды у 10,9% пациентов с острым болевым скротальным синдромом, объясняя его меньшую по отношению к иным формам синдрома острой мошонки частоту, по данным литературы, тем, что врачи-урологи и специалисты ультразвуковой диагностики взрослой сети не ориентированы на данную патологию и не включают её в диагностический ряд [12]. В серии наблюдений H. Sakurai et al (1983) удельный вес патологии гидатиды в структуре острых заболеваний органов мошонки ещё выше и достигает 20% [13].…”