Testicular appendage torsion resulting in testicular ischemia and necrosis in a child

Abstract

Torsion of intrascrotal appendages is the most common cause of acute scrotum in children, comprising 40 %–60% of the underlying cause of this entity. Torsion of the testicular appendages can be managed conservatively because it spontaneously necroses, disappears, and does not cause testicular dysfunction without blocking testicular blood flow. Our patient had a relatively large torsed testicular appendage, and we performed conservative treatment because there was no spermatic cord torsion. Clear blood flow to the testis was confirmed by ultrasonography examination, but the testicular blood flow was blocked and, as a result, there was testicular necrosis. The aim of this case report is to warn that testicular necrosis can occur even in torsed testicular appendage, which presents conventional ultrasonic findings and can rule out torsion of the spermatic cord. • Torsion of intrascrotal appendages is the most common cause of acute scrotum in children, and it generally can be managed conservatively because it does not cause testicular dysfunction without blocking the testicular blood flow. • Our case of torsed testicular appendage resulted in necrosis despite maintenance of spermatic cord blood flow on ultrasonography examination. • This is the first case report showing that a torsed appendage may have blocked testicular blood flow and caused testicular necrosis.