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Torsion of the Appendices and Epididymis

Epididymis Appendix Torsion


Presentation

  • This blue dot sign is present in 10% to 23% of patients with torsion of the appendix testis. 34,42 Over time, scrotal edema can obscure the physical findings.[aafp.org]
  • Background Torsion of testicular appendages can result in the clinical presentation of acute scrotum.[emedicine.medscape.com]
  • If present, tenderness is localized to the upper pole of the testis. Diffuse tenderness is more common in testicular torsion.[emedicine.medscape.com]
  • The appendix testis (or hydatid of Morgagni ) is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time.[en.wikipedia.org]
  • Torsion can present with varying degrees of rotation, which may explain the diverse clinical presentations encountered.[racgp.org.au]
Heart Failure
  • Systolic and Diastolic Heart Failure. No known association. D. Coronary Artery Disease or Peripheral Vascular Disease. No known association. E. Diabetes or other Endocrine issues. Testicular torsion may be cause of infertility later in life.[clinicaladvisor.com]
Testicular Pain
  • Background : Management of chronic idiopathic testicular pain may be difficult because of problems identifying the causes.[pubfacts.com]
  • Case 4 was a 19-year-old male who suffered from right testicular pain for the past seven days. He had a history of three intermittent episodes of similar right testicular pain during the past two years.[ncbi.nlm.nih.gov]
  • Testicular and Scrotal Conditions The Acute Scrotum Torsion of the Appendix Testis or Epididymis The presentation of a patient with torsion of the appendix testis (ie, acute testicular pain and swelling) is similar to that of a patient with testicular[aafp.org]
  • PREOPERATIVE DIAGNOSIS: Right testicular pain. POSTOPERATIVE DIAGNOSIS: Right hydrocele, right appendix testis.[supercoder.com]
  • Clinical significance [ edit ] Torsion [ edit ] The appendix of testis can, occasionally, undergo torsion (i.e. become twisted), causing acute one-sided testicular pain and may require surgical excision to achieve relief.[en.wikipedia.org]
Scrotal Mass
  • Anorchia (Medical Encyclopedia) Hydrocele (Medical Encyclopedia) Hydrocele repair (Medical Encyclopedia) Hypogonadotropic hypogonadism (Medical Encyclopedia) Orchitis (Medical Encyclopedia) Scrotal masses (Medical Encyclopedia) Testicle lump (Medical[icdlist.com]
  • A 16-HOUR-OLD boy was found to have a scrotal mass, on his initial physical examination. Exploration at 18 hours of age revealed a necrotic appendix testis (hydatid of Morgagni).[jamanetwork.com]
  • Appendiceal torsion, Torsed appendage, Epididymitis, Idiopathic scrotal edema, Acute scrotum – vasculitis, Henoch-Schonlein Purpura, Acute scrotal pain – US, Algorithm, Acute scrotum – trauma, Hematocele, Testicular hematoma, Trauma, Testicular fracture, Scrotal[sonoworld.com]
  • Incarcerated inguinal hernia – Pain with a scrotal mass. Bowel sounds may be present. HSP – acute or insidious onset of pain. Look for other signs of HSP. Doppler will differentiate. Trauma – Elicit corresponding history.[pedclerk.bsd.uchicago.edu]
Testicular Disease
  • The ICD code N44 is used to code Testicular disease Testicular diseases can be classified as endocrine disorders or as a disorders of the reproductive system.[icd.codes]
  • Research of Torsion Of Appendix Of Epididymis has been linked to Spermatic Cord Torsion, Edema, Torsion Abnormality, Testicular Diseases, Pain In Scrotum.[novusbio.com]
Swelling of the Scrotum
  • Diagnosis Any swelling in the scrotum is torsion of the testis until proven otherwise. The child must be seen immediately because time is critical in trying to salvage the testis. Usually the diagnosis is made clinically.[pedclerk.bsd.uchicago.edu]
  • Presentation Acute swelling of the scrotum in a boy indicates torsion of the testis until proven otherwise.[patient.info]
Epididymal Tenderness
  • tenderness with or without testicular tenderness WBC, LE, nitrites Body of testis similar to asymptomatic side with hypoechoic epididymis Antibiotics Possible scarring, possible impaired fertility While ultrasound is the most useful diagnostic modality[cdemcurriculum.com]
  • There is also noted diffusely tender swollen testes or epididymal tenderness. Scrotal swelling and erythema and reactive hydrocele may also be present in delayed presentations.[clinicaladvisor.com]

Workup

  • Testicular torsion is doubtful, and no further workup is indicated. Patients may be treated with narcotic analgesics if needed (nonsteroidal anti-inflammatory drugs [NSAIDs] if not contraindicated) and antibiotics.[aneskey.com]
  • Owing to the local policy during the study period, CDUS was not yet a part of the diagnostic workup of the acute scrotum.[dovepress.com]
  • Acute testicular torsion in children: the role of sonography in the diagnostic workup. Eur Radiol 2006;16:2527–32. Mirochnik B, Bhargava P, Dighe MK, Kanth N. Ultrasound evaluation of scrotal pathology. Radiol Clin North Am 2012;50:317–32, vi.[racgp.org.au]

Treatment

  • Here, the practicing urologist will find informative, easy-to-read reviews of the modern evaluation of prenatal hydronephrosis, the standard treatment of reflux vs the newer injectable techniques, and the spectrum of hypospadias treatment along with new[books.google.de]
  • […] is an approach that improves the quality of life of patients and their families facing the problems associated with lifethreatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment[books.google.de]
  • Conservative treatment is indicated, as this is a self-limited process. Infarction and subsequent atrophy of the appendage will occur. 26[aafp.org]
  • In most cases, testicular cancer can be cured if the person seeks medical treatment early. Surgical removal of the affected testicle (orchidectomy) is usually the first treatment for all testicular cancer.[betterhealth.vic.gov.au]

Prognosis

  • Torsion of testicular appendices is the leading cause of acute scrotum in children. [2, 3, 5, 6] Prognosis The prognosis is excellent. Long-term sequelae to this condition do not exist. Virtually all patients have uneventful recoveries.[emedicine.medscape.com]
  • Prognosis This will depend on the duration of torsion and the viability of the testis after detorsion has been performed. Some authors report decreased fertility when a testis is left in situ following a unilateral torsion.[pedclerk.bsd.uchicago.edu]
  • Subfertility is found in 36-39% of patients after torsion. [ 4 ] Prognosis The extent and duration of torsion have a major influence on both the immediate salvage rate and late testicular atrophy.[patient.info]
  • Prognosis and Patient Counseling. There can be psychological issues which occur with losing a testicle. Not only is there the cosmetic deformity but also the concerns of infertility. Saline implant prosthetic device may be helpful. VI.[clinicaladvisor.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • The 3 most common etiologies of acute scrotal pain in the pediatric age group are epididymitis, torsion of the appendix testis, and testicular torsion.[scholars.northwestern.edu]
  • Torsion of the appendix testis is a common cause of acute scrotal pain in children. [ Boettcher, 2013 ; Sakellaris, 2008 ] Etiology of torsion is unknown. Usually occurs in boys 7-14 years of age. More common than epididymitis in children.[pedemmorsels.com]
  • A urinalysis is sometimes obtained to access for pyuria or bacturia which would suggest an infectious etiology.[clinicaladvisor.com]
  • Viral etiologies most common, but can also be bacterial (brucellosis). Incarcerated inguinal hernia – Pain with a scrotal mass. Bowel sounds may be present. HSP – acute or insidious onset of pain. Look for other signs of HSP.[pedclerk.bsd.uchicago.edu]

Epidemiology

  • Epidemiology Most common in boys under age 3-5 years up to age 12 years old III. Differential Diagnosis IV.[fpnotebook.com]
  • Epidemiology Frequency United States Torsion of testicular appendices is one of the most common causes of acute scrotum; it is the leading cause of acute scrotum in children.[emedicine.medscape.com]
  • Epidemiology Testicular torsion is a common urological emergency among adolescent boys and young men. The condition typically occurs in neonates or post-pubertal boys but can occur in males of all ages.[patient.info]
  • Definition and epidemiology Testicular torsion is ischaemia of the testicle due to rotation along the longitudinal axis of the spermatic cord.[racgp.org.au]
Sex distribution
Age distribution

Pathophysiology

  • Testicular torsion must be diagnosed quickly and accurately, because delay of the diagnosis and subsequent delay of surgery, if needed, can lead to loss of testicular viability and orchidectomy. [1] Pathophysiology The vestigial tissues forming the appendices[emedicine.medscape.com]
  • Pathophysiology During development, the testicle becomes invested by the tunica vaginalis, to which it is fixed inferiorly by the gubernaculum testis.[pedclerk.bsd.uchicago.edu]

Prevention

  • Prevention of bacterial endocarditis. ‎[books.google.de]
  • This is to help prevent severe problems. During surgery, the health care provider will be able to see if the condition is testicular appendage torsion.[saintlukeshealthsystem.org]
  • Torsion of the other testicle can't be prevented by changes in activity or by taking medicine. Only sewing stitches around the testicle will prevent future torsion.[practo.com]
  • […] last at least 6 - 24 hours to cause an infarct Torsion without an infarct causes infertility proportionate to duration of torsion Treatment Untwist and fix testis to dartos muscle or orchiectomy Note: opposite testis should be fixed to dartos muscle as preventive[pathologyoutlines.com]

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