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Torsion of Testicular Appendage – Hydatid Torsion

Definition

Torsion of Testicular Appendage is the rotation of the testicular appendix (hydatid of Morgagni) around its pedicle leading to a hemorrhagic necrosis.

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 Workup

Laboratory Tests

• Urine analysis
• Complete blood count, CRP

Imaging

Doppler ultrasonography of the testis: signs for torsion of testicular appendage are a mild hydrocele, an enlarged testicular appendix [fig. ultrasonography of hydatid torsion ] and evidence of testicular blood flow. The problem is the reliable differentiation between testicular torsion and torsion of testicular appendage. If testicular torsion cannot be ruled out, surgical exploration is warrented.

Ultrasonography of hydatid torsion: with hydrocele and a visible testicular appendix. With kind permission, Prof. Dr. R. Harzmann, Augsburg.

Treatment of Hydatid torsion

In principle, the torsion of testicular appendage is treated conservatively with analgesics. In case of surgical exploration, the testicular appendage is removed after coagulation of the basis.

References

  Deutsche Version: Hydatidentorsion