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Torsion of the Hydatid of Morgagni

Hydatid of Morgagni Torsion


Presentation

  • A further case is presented, complicated by infarction of the tube and ovary. SUMMARY 1. The term hydatid of Morgagni is defined and its embryology outlined. 2.[semanticscholar.org]
  • The clinical presentation of our patients was similar to the usual presentation of adnexal torsion, ie, acute localized abdominal pain and nausea. None had symptoms or signs of necrosis (ie, fever and leukocytosis).[journals.lww.com]
  • Torsion of the hydatid is of no consequence in itself except that it presents a similar picture to torsion of the testis which is a surgical emergency.[gpnotebook.co.uk]
  • Torsion can present with varying degrees of rotation, which may explain the diverse clinical presentations encountered.[racgp.org.au]
  • Image A Image B Appendix testis (Hydatid of Morgagni) Present in 90% of testis, usually at the anterior-superior aspect beneath the epididymis head.[auanet.org]
Pediatric Disorder
  • Is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified. Is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified.[plannedrecognizing.gq]
Pediatric Disorder
  • Is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified. Is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified.[plannedrecognizing.gq]
Abdominal Pain
  • All four patients presented with localized lower abdominal pain and nausea without fever. The abdominal pain was described as intermittent in three cases and as constant in the fourth.[journals.lww.com]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself[nejm.org]
  • In uncomplicated cases of diverticulitis, patients present with abdominal pain typically in the left lower quadrant with tenderness to palpation in the same area. Patients should not have peritoneal signs or masses on examination.[pinterest.de]
  • pain. nausea and vomiting may occur history of trauma in 20% prior episodes in 30% testes is exquisitely tender but may look normal initially and then develop swelling and oedema “bell clapper” testicle has a transverse lie testis redux Mx in adolescents[ozemedicine.com]
  • May have associated vasculitic rash of buttocks and lower limbs, arthritis, abdominal pain with GI bleeding, and nephritis May be difficult to distinguish from testicular torsion in absence of other features Testicular or epididymis rupture Scrotal trauma[emed.ie]
Lower Abdominal Pain
  • III Adnexal torsion involving the hydatids of Morgagni may be underreported and should be considered in the differential diagnosis of acute lower abdominal pain among adolescents.[journals.lww.com]
  • abdominal pain. nausea and vomiting may occur history of trauma in 20% prior episodes in 30% testes is exquisitely tender but may look normal initially and then develop swelling and oedema “bell clapper” testicle has a transverse lie testis redux Mx[ozemedicine.com]
  • Presentation Usually there is an acute onset of pain in the scrotum or testis, however the patient may complain of inguinal or lower abdominal pain. Associated nausea and vomiting is very common.[pedclerk.bsd.uchicago.edu]
  • There may be lower abdominal pain and, in any boy presenting with abdominal pain, the testes should be checked. It often comes on during sport or physical activity. There is quite often a history of previous, brief episodes of similar pain.[patient.info]
Abdominal Tenderness
  • The physical examination revealed abdominal tenderness in all cases. In addition, the per rectal examination detected a round, tender, and mobile pelvic mass in three of the patients.[journals.lww.com]
  • Pathophysiology Clinical features Abrupt onset testicular pain and/or pain in the lower abdomen Typically swollen and tender testicle and/or lower abdominal tenderness Nausea and vomiting Abnormal position of testicle Absent cremasteric reflex Prehn sign[amboss.com]
  • Uterus felt bulky but was difficult to assess due to abdominal tenderness, however bilateral adnexal fullness and tenderness was noted. Vaginal examination showed posterior cervical lip which was hypertrophied and spotting was present.[jpma.org.pk]
Left Lower Quadrant Pain
  • No specific left lower quadrant pain was reported. Hydatids of Morgagni are common findings at pelvic surgery and usually of no clinical significance. Torsion of a hydatid of Morgagni is rarely reported and most likely is a rare occurrence.[ncbi.nlm.nih.gov]
  • No specific left lower quadrant pain was reported. CONCLUSION: Hydatids of Morgagni are common findings at pelvic surgery and usually of no clinical significance.[reproductivemedicine.com]
Pelvic Mass
  • In addition, the per rectal examination detected a round, tender, and mobile pelvic mass in three of the patients.[journals.lww.com]
Purpura
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • Henoch Schonlein purpura Painful scrotal oedema, with purpuric rash over scrotum.[emed.ie]
  • Other conditions to be considered in the differential diagnosis are hernia, tumors, Henoch–Schönlein purpura, trauma, varicocele, and hydrocele.[link.springer.com]
  • […] interstitial hemorrhage Later neutrophils in capillaries; at 4 days see hemorrhagic infarction and coagulative necrosis Later granulation tissue; years later may see fibrosis and calcification Differential diagnosis Testicular pain due to Henoch-Schönlein purpura[pathologyoutlines.com]
  • OF AN ACUTE SCROTUM IN CHILDREN Torsion of testicular appendage (hydatid of Morgagni) Epididymitis Orchitis Hernia Varicocele Hydrocele Tumour Ectopic spleen or adrenal tissue Trauma Cellulitis Idiopathic scrotal oedema Fat necrosis Henoch-Sconlein purpura[bjfm.co.uk]
Encephalopathy
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Headache
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Dysuria
  • Historical features, such as fever, nausea, vomiting, dysuria, sexual activity, and history of trauma, were not helpful discriminators.[ahcmedia.com]
  • This was not preceded by trauma, dysuria or any scrotal swelling. On exam the right testicle was tender to palpation. It seemed to be at higher lie than the left. There was no large hydrocele. There was no edema or erythema of the scrotum.[supercoder.com]
  • […] disease, not infection. [ Rakha, 2006 ] Clinical History and Exam are helpful, but not conclusive “Classic” signs : Localized tenderness at the superior pole Blue Dot sign Preserved cremasteric reflex Findings that favor Epididymitis: [ Boettcher, 2013 ] Dysuria[pedemmorsels.com]
  • Epididymoorchitis RARE pre-pubertal (unless underlying genitourinary abnormality associated with UTI) Adolescents with STI Insidious onset Fever Urinary symptoms – dysuria, frequency Urethral discharge May have history of recent instrumentation – catheter[rch.org.au]
Scrotal Mass
  • mass – either enlarged or atrophied Possible acute inflammation : swollen, erythematous (or blue discolored in venous engorgement), and tender hemiscrotum Testicular torsion should always be suspected in a male patient with severe, sudden-onset testicular[amboss.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]
  • If the torsion occurs prenatally, the baby is born with a firm, hard, non-transilluminable scrotal mass. There are no symptoms. The scrotal skin is usually fixed to the underlying necrotic testis.[patient.info]
  • “Evaluation of scrotal masses.” American family physician 89.9 (2014). – DaJusta, Daniel G., et al. “Contemporary review of testicular torsion: new concepts, emerging technologies and potential therapeutics.”[emdocs.net]
Swelling of the Scrotum
  • Abstract Out of 82 patients with acute swelling of the scrotum, 25 (30.5%) had hydatid torsion. Hydatid torsion was the second most common cause of acute scrotal swelling in the entire patient group.[ncbi.nlm.nih.gov]
  • 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]
Testicular Disease
  • Research of Torsion Of Appendix Of Epididymis has been linked to Spermatic Cord Torsion, Edema, Torsion Abnormality, Testicular Diseases, Pain In Scrotum.[novusbio.com]
Cesarean Section
  • Authors , , Source MeSH Acute Disease Adult Cesarean Section Fallopian Tube Diseases Female Humans Infant, Newborn Laparotomy Parovarian Cyst Pregnancy Pregnancy Complications Torsion Abnormality Treatment Outcome Ultrasonography Pub Type(s) Case Reports[unboundmedicine.com]

Workup

  • 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]
Nephrolithiasis
  • Three of the patients were ordinarily healthy, whereas the fourth had had nephrolithiasis. All four patients presented with localized lower abdominal pain and nausea without fever.[journals.lww.com]

Treatment

  • Early diagnosis, prompt treatment, and preventive measures are important to avoid testicular infarction. Occurrence of torsion has been previously reported following orchidopexy for undescended testis and for previous torsion of the testis.[link.springer.com]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself[nejm.org]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • Torsion of the testis is a surgical emergency that requires treatment within a few hours and also has the same symptoms.[thecorrect.com]

Prognosis

  • […] testes_torsion introduction intratunical torsion of the testes is a surgical emergency as infarction of the testes increases with time, and with durations exceeding 4 hours from onset, prognosis becomes poor patients with suspected torsion of testes are[ozemedicine.com]
  • , explain and gain consent for possible orchidectomy bilateral fixation Prognosis if surgery performed 24hrs later, 0 - 10% Source OHCM 9th Ed 2014 Harrison's 18th Ed 2012 Toronto Notes 2012[simplifiedmed.weebly.com]
  • References: [1] [7] Prognosis[amboss.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]
  • 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]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • * PREDISPOSING FACTORS * PRECIPITATING FACTORS PREDISPOSING FACTORS in Etiology of Torsion Testis 1.[brainscape.com]
  • The etiology of this condition can be correlated with the morphological characteristics of the hydatid present in children and young adults.[pediatrics.aappublications.org]
  • […] infertility and may play a role in infertility (possibly due to interference with tubal pick up and function) Epidemiology Common incidental and benign finding ( 4% of women, 10% of adnexal masses) All age groups, most commonly third to fifth decade Etiology[pathologyoutlines.com]

Epidemiology

  • His interests are in incontinence in the elderly, the effects of medication and co-morbidity on continence status and the epidemiology and aetiology of incontinence in the elderly.[books.google.com]
  • 100,000 males below the age of 18 References: [1] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Definition twisting of spermatic cord that ‘holds’ the testes — blood supply cut off — schema — necrosis Aetiology mostly idiopathic, congenital, post trauma Epidemiology any age, most often 11-30yo Clinical Features Symptoms sudden onset of severe pain[simplifiedmed.weebly.com]
  • Epidemiology Most common in boys under age 3-5 years up to age 12 years old III. Differential Diagnosis IV.[fpnotebook.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The testicle can twist and tighten up around the spermatic cord. The twist can happen outside of the scrotum, normally at the external inguinal ring, or inside of the scrotum.[paediatricem.blogspot.com]
  • Pathophysiology Clinical features Abrupt onset testicular pain and/or pain in the lower abdomen Typically swollen and tender testicle and/or lower abdominal tenderness Nausea and vomiting Abnormal position of testicle Absent cremasteric reflex Prehn sign[amboss.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]
  • 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]

Prevention

  • Early diagnosis, prompt treatment, and preventive measures are important to avoid testicular infarction. Occurrence of torsion has been previously reported following orchidopexy for undescended testis and for previous torsion of the testis.[link.springer.com]
  • Prevention of bacterial endocarditis. ‎[books.google.de]
  • The vast majority of this unnecessary surgery and its complications could have been prevented by timely and accurate CDUS.[omicsonline.org]
  • 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.[sterlingcare.com]

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