Presentation
It is present about 90% of the time. It has no physiological function. [humpath.com]
Mild hydrocele may or may not be present. [sumerdoc.blogspot.com]
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]
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. [wikidoc.org]
Entire Body System
- Pain
Additionally, there was no history of trauma, change in bowel habits or genitourinary symptoms prior to the onset of the pain. [panafrican-med-journal.com]
All pain and symptoms experienced by the patient during the previous day were associated with the onset of labor. No specific left lower quadrant pain was reported. [ncbi.nlm.nih.gov]
As there are many differences between acute pain - clinical as well as experi mental - on the one hand and chronic pain symptoms on the other, it was felt preferable to limit the scope of this book essentially to chronic and recurrent pain in gynecologic [books.google.com]
The twisting can cut off its blood supply, causing pain that ranges from mild to severe. The pain usually gets better after a week or two. There is usually no treatment except to make your child as comfortable as possible. [myhealth.alberta.ca]
[…] by · Published June 17, 2016 · Updated July 25, 2017 Acute scrotal pain will always grab both patient’s and providers’ attention, appropriately. We have already discussed the most feared cause of acute scrotal pain – Testicular Torsion. [pedemmorsels.com]
- Swelling
In the neonate the usual cause of scrotal swelling is either idiopathic infarction of the testis or supravaginal torsion of the spermatic cord. [thieme-connect.com]
Discuss with Paediatric surgeon Incarcerated hernia Intermittent inguinoscrotal swelling, associated irritability +++Pain Worse with crying Nausea and Vomiting – if bowel entrapment Firm, tender, irreducible inguinoscrotal swelling Requires reduction [rch.org.au]
[…] with definite epididymitis, and a remaining group with nonspecific swelling and tenderness. [scienceopen.com]
Incarcerated inguinal hernia History of intermittent inguinoscrotal bulge, with associated irritability Firm, tender, irreducible, inguinoscrotal swelling Idiopathic scrotal oedema Swelling noted but child not distressed Bland violaceous oedema of scrotum [emed.ie]
The boy had severe pain in the right scrotum with mild swelling. [ultrasound-images.com]
- Inflammation
Abstract In this manifestation at the result of being operated on the suspicion of appendix testis, in another words, Hydatid of Morgani, the inflammative appendix testis (one is torsion and another is not torsion) was recognized, then the manifestation [jstage.jst.go.jp]
Diverticulitis is an inflammation of the diverticulum in the large intestine. In uncomplicated cases of diverticulitis, patients present with abdominal pain typically in the left lower quadrant with tenderness to palpation in the same area. [pinterest.de]
The clinical implications and consequences of this associated inflammation are not clear. Methods: A retrospective review of all cases presenting with torsion of the testicular appendix between 1987 and 2005 was carried out. [jcp.bmj.com]
[…] schema —> necrosis Aetiology mostly idiopathic, congenital, post trauma Epidemiology any age, most often 11-30yo Clinical Features Symptoms sudden onset of severe pain in one testes which makes walking difficult, abdo pain, N&V, lightheadedness Signs inflammation [simplifiedmed.weebly.com]
The necrotic tissue will lead to local inflammation and, thus, mimic epididymitis. [ Boettcher, 2013 ] Inflammatory cells infiltrate the twisted appendix testis and are a marker of progression of the disease, not infection. [ Rakha, 2006 ] Clinical History [pedemmorsels.com]
- Gangrene
Tests for Hydatid of Morgagni The diagnosis is only made during surgery, after ensuring that the testis itself has not become twisted and gangrenous. [thecorrect.com]
The diagnosis is only made during surgery, after ensuring that the testis itself has not become twisted and gangrenous. [afairgo.net]
Emergency exploration is mandatory because of the difficulty in differential diagnosis from torsion of the spermatic cord with gangrene of the testis. [pediatrics.aappublications.org]
Fournier's gangrene of the scrotum. Infectious conditions within the scrotal wall are also classified under the acute scrotum and include cellulitis and fasciitis (gangrene). [auanet.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 Believed [pathologyoutlines.com]
“nutcracker effect”). primary varicoceles: occurs in 15-20% of all males, usually first presenting at age 15-30 years occurs in 40% of infertile males presumably as it impairs testicular thermoregulation and is the most common cause of infertility 35- [ozemedicine.com]
Torsion of appendix epididymis N44.1 Cyst of tunica albuginea testis N44.2 Benign cyst of testis N44.8 Other noninflammatory disorders of the testis N45 Orchitis and epididymitis N45.3 Epididymo-orchitis N45.4 Abscess of epididymis or testis N46 Male infertility [icd10data.com]
The links between varicocele and infertility are not fully understood and research is ongoing. [betterhealth.vic.gov.au]
Cardiovascular
- Hypertension
Delivery Models Health Care Economics, Insurance, Payment Health Care Policy Health Care Quality Health Care Reform Health Care Safety Health Care Workforce Health Disparities Health Informatics Health Policy Hematology History of Medicine Humanities Hypertension [jamanetwork.com]
Lastly, scrotal edema secondary to hypoalbuminemia, portal hypertension and lymphadenopathy are also rare but significant conditions that may occur under the aegis of the acute scrotum. [auanet.org]
Short-term Long-term secondary bleeding formation of arteriovenous fistulae abscesses encysted hematomas urinomas development of hypertension These complications are generally seen after injuries in which segments of parenchyma are devascularized or extensive [elearning.sumdu.edu.ua]
Skin
- Erythema
Clinically present with pain ,erythema & swelling of ipsilateral hemiscrotum. [sumerdoc.blogspot.com]
The two sides should be assessed for discrepancies in size, degree of swelling, presence and location of erythema, thickening of the skin and position of the testis. [aafp.org]
There was no edema or erythema of the scrotum. I also looked at the scrotal ultrasound which showed minimal flow to the right testicle, especially compared to the left. [supercoder.com]
Symptoms Sudden onset, severe testicular pain - in 2/3 of the canal Half of all torsions start in the night time Pain not relieved by elevation of the scrotum Swelling of the testis or scrotum, oedema or erythema of scrotal skin Pain may be referred to [paediatricem.blogspot.com]
There is usually an associated hydrocoele with scrotal wall erythema; however, these are common examination findings of many diagnoses of acute scrotal pain. 7 If elevation of the scrotum does not relieve the pain (negative Prehn’s sign) testicular torsion [racgp.org.au]
Psychiatrical
- Suggestibility
These ultrasound findings suggest torsion of the right testes with hydrocele. [ultrasound-images.com]
A spherical shape and size of 6 mm with no internal vascularity and peripherial vascularity on Doppler scan are highly suggestive of torsion. torsion of the testis [radiopaedia.org]
Eighteen per cent had a definite diagnosis of acute epididymitis (i.e., three nonpathognomonic but suggestive findings of acute epididymitis or two suggestive findings plus a radionuclide scan showing bilateral perfusion); nonoperative therapy is indicated [scienceopen.com]
Unilateral swelling without skin changes suggests the presence of a hernia or hydrocele. The duration of symptoms is also relevant. [aafp.org]
Diagnosis Suggestive features on history Suggestive features on examination Torsion of the testis Sudden onset testicular pain and swelling; occasionally nausea, vomiting. [emed.ie]
Neurologic
- Stroke
[…] antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke [books.google.de]
The cremasteric reflex (L1/L2 spinal nerves) - gentle pinching or stroking of the inner thigh while observing the scrotal contents. [emed.ie]
The cremasteric reflex (L1/L2 spinal nerves) is elicited by gentle pinching or stroking of the inner thigh while observing the scrotal contents. If the torsion occurs prenatally, the baby is born with a firm, hard, non-transilluminable scrotal mass. [patient.info]
The cremaster reflex is elicited by lightly stroking the skin of the inner thigh causing the cremaster muscle to contract and elevate the testicle. The odds ratio for absence of a cremaster reflex has been reported from 4.8-27.8. [emdocs.net]
This reflex is elicited by stroking the ipsilateral thigh which leads to reflex elevation of the ipsilateral testicle by greater than 0.5cm. Diagnostic Testing Laboratory analysis of blood and urine is usually not helpful. [cdemcurriculum.com]
- Irritability
Discuss with Paediatric surgeon Incarcerated hernia Intermittent inguinoscrotal swelling, associated irritability +++Pain Worse with crying Nausea and Vomiting – if bowel entrapment Firm, tender, irreducible inguinoscrotal swelling Requires reduction [rch.org.au]
Incarcerated inguinal hernia History of intermittent inguinoscrotal bulge, with associated irritability Firm, tender, irreducible, inguinoscrotal swelling Idiopathic scrotal oedema Swelling noted but child not distressed Bland violaceous oedema of scrotum [emed.ie]
Importantly, with torsion, signs of infection are usually absent: patients are usually afebrile, free of irritative voiding symptoms such as dysuria, and harbor a normal urinalysis and normal white blood cell count. [auanet.org]
Irritation from soaps, bubble baths, laundry detergent, and antistatic sheets have also been implicated. Balanitis in children usually arises from an infection of the smegma on the basis of a phimosis or non-retractile foreskin. [elearning.sumdu.edu.ua]
Urogenital
- Scrotal Pain
[…] by · Published June 17, 2016 · Updated July 25, 2017 Acute scrotal pain will always grab both patient’s and providers’ attention, appropriately. We have already discussed the most feared cause of acute scrotal pain – Testicular Torsion. [pedemmorsels.com]
The diagnosis of acute scrotal pain can be one of the most interesting and challenging aspects in medicine. [racgp.org.au]
Diagnosing acute scrotal pain and swelling in children and adolescents is urgent and often difficult. [scienceopen.com]
[…] of other scrotal condition. [medical-dictionary.thefreedictionary.com]
- Testicular Pain
[…] always be suspected in a male patient with severe, sudden-onset testicular pain ! [amboss.com]
Diagnosis Features on history Features on exam Management Surgical Causes Testicular torsion Peak neonates and adolescents 13-16years Sudden onset unilateral testicular pain and swelling Pain usually constant May be pain in iliac fossa May follow minor [rch.org.au]
Furthermore, whilst CDUS was useful in confirming/ruling out testicular torsion, its utility in diagnosis of other causes of acute testicular pain in our series was limited. [omicsonline.org]
Signs and Symptoms of Hydatid Torsion Testicular pain Edema of the scrotum Blue dot sign: the hemorrhagic infarcted appendix testis can be seen through the scrotum Diagnostic Work-Up Laboratory Tests Urine analysis Complete blood count, CRP Imaging Doppler [urology-textbook.com]
PREOPERATIVE DIAGNOSIS: Right testicular pain. POSTOPERATIVE DIAGNOSIS: Right hydrocele, right appendix testis. [supercoder.com]
- Swelling of the Scrotum
Sonography of the scrotum was done in this child who had acute swelling of the scrotum and penis. [ultrasound-images.com]
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]
H ydroc ele A hydrocele is the most common cause of scrotal swelling. The normal scrotum contains small amounts of serous fluid between the layers of the tunica vaginalis. [acep.org]
- 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]
May have scrotal edema and discoloration. 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. [pedclerk.bsd.uchicago.edu]
The cremasteric reflex (L1/L2 spinal nerves) is elicited by gentle pinching or stroking of the inner thigh while observing the scrotal contents. If the torsion occurs prenatally, the baby is born with a firm, hard, non-transilluminable scrotal mass. [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]
- Cryptorchidism
Intra-operative findings revealed torsion of the appendix testis in an inguinal cryptorchid testicle. The spermatic cord was untwisted and no associated hernia sac was identified. The necrotic appendix was excised and cryptorchidism corrected. [panafrican-med-journal.com]
The epididymal anomalies are associated with cryptorchidism, with an incidence that ranges from 36 to 79% (14,15). The incidence of testicular and epididymal appendages is seldom reported in patients with cryptorchidism. [brazjurol.com.br]
Teelbaltorsie of torsio testis symptomen Cryptorchidism or undescended testis. WebMD explains testicular torsion, including causes, symptoms, and treatment. [plannedrecognizing.gq]
Diagnostic Considerations Torsion of the cryptorchid testis can be very challenging to diagnose. [emedicine.medscape.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]
Treatment
Comprehensive overview covers symptoms, treatment of this condition. [plannedrecognizing.gq]
Usually no treatment other than to manage pain is needed. How Boston Children's Hospital treats torsion of the appendix testis Because torsion of the appendix testis poses no threat to the overall health of your son, treatment is relatively simple. [childrenshospital.org]
[…] 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]
Torsion of morgagni hydatid in «acute scrotum» syndrome Abstract The results of operative treatment of 252 patients aged from 3 months to 20 years (mean age 9,9±2,9 years) hospitalized with acute pain in the scrotum were demonstrated. [journals.uran.ua]
Treatment of Torsion Testis * Indication * Operative management Indication of Treatment of Torsion Testis The condition is highly emergency and infraction of the testes occurs in 6 hrs Operative management in Treatment of Torsion Testis 1. [brainscape.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]
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]
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]
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]
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 [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]
Pathophysiology
The pathophysiological basis of surgical diseases is discussed in relation to their management, acting as a bridge between basic medical sciences and clinical problems. [books.google.com]
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
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]
Surgery is the accepted form of treatment, because it provides prompt relief from the pain, prevents recurrence and, in some cases, is required to rule out torsion of the spermatic cord. [pediatrics.aappublications.org]
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]