Torsion Of Appendix Research Articles

016. Case Report: Torsion of the Testicular Appendix in Pediatric

Background: The testicular appendix or hydatidosa sessile Morgagni is a congenital disorder consisting of residual vestigial tissue of the mesonephric and Müllerian ducts1. Commonly it is attached to the testis and caput epididymis. Its presence can lead to twist around their own axis, causing acute scrotal pain. Case: A 8-year-old boy presented with gradual onset of left scrotal pain that worsened with movement and improved with rest. Other symptoms included scrotal swelling and redness/hyperemis. The ultrasonography examination revealed torsion of the testicular sinistra with mild hydrocele. During surgical intervention, testicular of the appendix torsion was found and appendiceal excision was performed. Conclusion: Torsion of thetesticulsr appendix is a benign condition that commonly affects prepubertal males. Its atypical symptoms of acute scrotal pain can lead to misdiagnosis as testicular torsion.

The Impact of the Sonographic Findings Within the Epididymis on the Differential Diagnosis of Acute Scrotum

Objective: The aim of this study was to assess the sonographic changes within the testis, epididymis, and the corresponding appendages, in contributing to the pediatric differential diagnosis, of an acute scrotum. Materials and Methods: A retrospective extraction of pediatric patients’ (age <13 years) data was completed for those initially seen with an acute scrotum. The data procured from the medical records included demographic characteristics, clinical and sonographic findings, and the final diagnosis. Results: The final diagnoses among a cohort of 86 pediatric males (average age 6 ± 3.9 years) with acute scrotum were as follows: epididymal and testicular appendix torsion (44.7% and 17.6%, respectively), testicular torsion (15.3%), trauma and hematoma (5.9%), incarcerated hernia (4.7%), idiopathic scrotal edema (4.7%), epididymitis (4.7%), and Henoch-Schonlein purpura (3.5%). The heterogeneous testicular appearance in patients with testicular torsion was significantly compared with the appendix torsion. The increased testicle size noted on the sonogram favored the diagnosis of testicular torsion. In cases of testicular torsion, the vascular flow was reduced or absent, although it was normal or increased in appendix torsion. Increased epididymal vascular flow was more common in cases of appendix torsion. Conclusion: Based on the diagnostic findings in this cohort, the following were the most common and accurate sonographic findings in distinguishing the causes of a pediatric acute scrotum: an epididymis enlargement coexisting with a small adjacent avascular mass, due to the torsion of intra-scrotal appendages and a mass shape of the epididymis.

Testicular appendix (hydatid of Morgagni) torsion in adult urological management: evaluation of treatment outcomes

Introduction. Testicular appendix (hydatid of Morgagni) torsion (TAT) is relatively rare in patients over 18 years of age. To date, there are no systematised data on the long-term results of TAT treatment depending on the diagnostic and therapeutic tactics undertaken. Accordingly, there are no clear algorithms for the management of such patients.Objective. To evaluate and compare long-term results of various treatment options for patients with testicular appendix torsion over the age of 18 years.Materials & methods. The age of patients is from 18 to 46 years. We analysed the treatment results of TAT-patients in three comparison groups: those who received conservative treatment for uncomplicated course of the disease (group 1, n = 17), early surgical treatment for complicated course (group 2, n = 16), and patients who were operated on for complicated course if conservative therapy was ineffective (group 3, n = 17). The exclusion criteria were concomitant scrotal pathology (hydrocele, funicular hydrocele, varicocele, epididymitis); severe somatic pathology (diabetes mellitus, hypertension, heart attack, stroke). Evaluation of long-term results was carried out 9 – 12 months after the acute episode. Scrotal ultrasound (US) and Doppler US of testicular vessels were compared, endocrine status (levels of total testosterone, luteinising hormone, follicle-stimulating hormone) and reproductive function were studied based on the results of semen analysis and MAR-test.Results. Analyses of long-term clinical data revealed recurrent orchalgia in 29.4% of patients in group 3. Also, in group 3, US revealed testicular asymmetry in 47.1% of patients accompanied by hypotrophy of the affected testis up to 20.8% of the volume compared to the contralateral testis. There were no significant changes and differences in groups 1 and 2. Evaluation of endocrine function showed no significant difference of the studied groups from the control normative indicators. Semen analysis parameters were not significantly changed in groups 1 and 2. In group 3, asthenozoospermia was found in 23.5% of cases, and teratozoospermia was detected in 29.4% of patients.Conclusion. Conservative treatment for TAT without inflammatory changes does not lead to impaired spermatogenesis and structural changes of both the testis and its appendix in the long-term follow-up period and is the most accepted in practice. Early surgical intervention for inflammatory changes shows similar long-term results. Prolonged conservative treatment for TAT in secondary orchoepidididymitis with delayed surgery significantly worsens long-term results. This fact also demonstrates the need for early surgery in complicated TAT.

Primary torsion of the appendix in a 10-year-old child

Introduction. Torsion of the appendix is a rare pathology with unclear pathogenesis. The article describes clinical manifestations, diagnostics and surgical management of the distorted appendix in a child. Observation. A 10-year-old boy was admitted to the hospital with pain in the right iliac region and repeated vomiting. During examination, acute appendicitis was diagnosed. At laparoscopy, appendix torsion was revealed; its detorsion and laparoscopic removal were performed. Intraoperatively, it was found out that the mesentery had narrow base , while the process length was about 7 cm; such a combination under developing inflammatory changes in the process could contribute to its torsion. Conclusion. Torsion of the appendix in children has a clinical, laboratory and echographic picture of the destructive appendicitis. Laparoscopy allows to timely clarify the pathology nature and to timely perform appendectomy.

Torsion of the vermiform process: clinical observations

Introduction. Torsion of the appendix is an extremely rare pathology in both adults and children. In this article, the authors report about two cases of appendix torsion which were revealed intraoperatively. Case description. Clinical observation 1: A 2-year-old boy was admitted to the surgical department with suspected acute appendicitis. On examination, the entire abdominal region was painful, the symptom of passive muscle defense was noted on the right. Ultrasound examination revealed changes in the appendix. Intraoperatively, torsion of the appendix was detected. Laparoscopic appendectomy was performed. The postoperative course was uneventful. Clinical observation 2: A 5-year-old boy was admitted to the surgical department with complaints of abdominal pain. Physical examination revealed the clinical picture of acute abdomen. At ultrasound examination, signs of altered appendix were seen. During diagnostic laparoscopy, torsion of the appendix was detected. Laparoscopic appendectomy was performed. The postoperative course was uneventful. Conclusion. The discussed two clinical cases indicate the necessity to include torsion of the appendix in the list of diagnoses for differential diagnostics in case of acute abdomen.

Torsion of cecal appendix. Report of the first Italian case and review of the literature

In pediatric patients appendicitis is the most common cause of abdominal pain and surgery. Torsion of vermiform appendix is a rare cause, clinically indistinguishable from appendicitis with usually an intraoperative diagnosis. The first description of vermiform appendix torsion was made by Payne in 1918. Clinical presentation is similar to acute appendicitis. Preoperative investigations play a minimal role. Etiology of this condition is unclear, but is possible to distinguish a primary and a secondary torsion. We report a case of 5-years-old boy who presented with right lower quadrant abdominal pain. His clinical signs, symptoms and investigations mimicked an acute appendicitis. Intraoperatively we found a 720° appendix torsion on its base with its mesentery rotated in counter-clockwise direction. The appendix was gangrenous in appearance. A video-assisted trans-umbilical appendectomy was performed. We describe clinical presentation and management of this rare condition reviewing the literature.

Nowadays treatment of testicular appendix torsion in children

Introduction. Currently, a modern tactics as to the treatment of testicular appendix torsion in children is not an indisputable axiom but it is a subject of discussion in domestic and foreign literature. Modern diagnostic tools, wide implementation of expert-class equipment as well as gaining more experience have reduced, to a minimum , the risk of diagnostic error with fatal consequences for the gonad. So, it impels to revise the existing algorithms and to consider the conservative treatment as the method of choice in uncomplicated testicular appendix torsion.Objective. To analyze the gained experience in treating testicular appendix torsion and to suggest reasonable algorithms which correspond to modern diagnostic techniques and treatment options. Material and methods. 2875 cases with testicular appendix torsion have been analyzed. Of these, 2 069 (71.96%) patients were operated on; 755 (26.26%) patients had conservative treatment and 51 (1.78%) had to be operated on despite conservative treatment.Results. The material obtained in three statistically homogeneous groups has been аnalyzed. When comparing clinical and ultrasound criteria, it was found out that the incidence of orchalgia in the surgical group is slightly higher than in the conservative one. It may indicate that the adhesive process in the scrotal cavity after surgical trauma is more frequent than after a possible aseptic inflammation. Asymmetry of gonad volumes with smaller diseased testicle was seen in all groups. The decrease in testicular volume is minimal in all cases and is not statistically significant. The incidence of heterogeneity in the testicular and appendage echo structure, which indicates sclerotic changes in the parenchyma, is also not statistically significant in the analyzed groups. Patients who were operated despite their conservative care do not have much worse outcomes after long-lasting follow-up period than groups with other curative options.Conclusion. Torsion of the testicular appendix in children is a challenging problem that is far from being solved. There is no consensus as to the indications for surgical treatment and to the assessment of postoperative outcomes. Modern diagnostic and monitoring techniques allow to dynamically monitor the scrotal organs in conservative treatment. The conservative treatment of testicular appendix torsion is an effective and safe method. The conservative tactics which was changed for surgical one does not lead to gonad deterioration.

Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution

Purpose: Testicular torsion (TT) is a serious surgical emergency. Prompt diagnosis and treatment of TT are essential to improve the incidence of salvaged testes. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. Materials and Methods: We retrospectively reviewed the records of 136 males who presented with TT to our institution. Clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, and the results of follow-up were collected and analyzed. Patients with neonatal torsion, negative scrotal exploration, or testicular appendix torsion were excluded. A multivariable logistic regression model was used to identify predictors of testicular salvage. Receiver operator characteristics analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting. Results: A total of 136 children with TT were identified. Patients were aged from 1 to 16 years, with a mean age of 9.7 years (median, 12; range, 1–16 years). The peak incidences of TT were found between ages of 12 and 14 years. Acute TT is significantly more common in the winter. Testicular salvage occurred in 49 (36%) cases. Of the 49 cases of testicular salvage, 5 patients developed subsequent testicular atrophy. Cutoff values of 13.5 h and 530 degrees of torsion would provide sensitivities of 96 and 61%, with specificity of 80 and 70%, respectively. Multivariate analysis showed that time to surgery and degree of testicular twist were correlated with the risk of a non-salvageable testis. Conclusions: Testicular salvage can be predicted by the duration of symptoms along with degree of twisting. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with lower abdominal pain should have their testicles checked to make sure that they do not have torsion, especially those visitors in cold season.

Assessment of Age and Duration of Symptoms on Outcomes of Emergency Scrotal Exploration for Acute Scrotal Pain.

To study the effects of age and duration of symptoms on the outcomes of scrotal explorations for acute scrotal pain at our institution. Case series. Bradford Teaching Hospital NHS Trust, from January 2006 to December 2017. Retrospective data was collected from electronic case records of the patients who required scrotal exploration for suspected torsion of the testis. Group difference between continuous variables (age and duration of symptoms) were assessed by Kruskal Wallis and independent samples Mann-Whitney U-tests. The Fisher Exact and Chisquare tests were used to analyse relationships between categorical data. In total, 502 patients required scrotal exploration. The median age (years) and duration of symptoms (hours) were 16.4 years (1.3 - 77) and 4 hours (1 - 336), respectively. Torsion of the testis was found in 231 (46%), torsion of the testicular appendix in 126 (25%), epididymal inflammation in 46 (9.2%), and no cause identified in 99 (19.7%). Immediate orchidectomy for non-viable testis performed in 34 (14.7% of TT group and 6.8% of the overall cohort). Duration of symptoms was significantly associated with risk of orchidectomy in torsion patients 4 vs. 27 hours (p <0.0001). Overall 47 (9.3%) patients presented after 12 hours, 22 (46.8%) had TT. There were 13 (2.6%) patients older than 40 years and 8 (61.5%) of these had torsion. The most commonest diagnosis for patients presenting with acute scrotal pain was torsion of the testis followed by torsion of appendix testis. Testicular salvage was inversely related to the duration of symptoms. Patient's age did not predict the need for orchidectomy. This data supports the practice of urgent scrotal exploration for acute scrotal pain with a clinical suspicion of torsion regardless of age and duration of symptoms.

Torsion of vermiform appendix: case report and review of the literature

BackgroundTorsion of the vermiform appendix is a rare disease with symptoms very similar to those of acute appendicitis. We herein report a case of torsion of the vermiform appendix diagnosed by intraoperative findings.Case presentationA 4-year-old boy presented to our hospital because of abdominal pain and vomiting. Laboratory data revealed a C-reactive protein level of 0.08 mg/dL and white blood cell count of 19,300/μL (neutrophils, 88.9%). Abdominal ultrasound showed a target sign-like finding in the ileocecal region. A computed tomography scan showed swelling of the appendix. We performed an emergency operation under suspicion of acute appendicitis. Laparoscopic examination showed that the appendix had twisted 720° in the clockwise direction. Appendectomy was performed, and the postoperative course was uneventful.ConclusionsAlthough torsion of the vermiform appendix is a very rare disease and difficult to differentiate from appendicitis, an inappropriate treatment plan could lead to necrosis and perforation of the appendix. It is important to consider this disease as a differential diagnosis in patients with right lower abdominal pain.

A rare case of Acute Abdomen: Torsion of Vermiform Appendix

A rare case of Acute Abdomen: Torsion of Vermiform Appendix

Primary torsion of vermiform appendix: A case report and review of literature

Appendicitis is the most common abdominal emergency with more than 250,000 appendectomy operations performed annually in the United States alone. Although appendicitis is the most common intra-abdominal surgical pathology, torsion of the appendix has only rarely been described and is an uncommon cause of an acute abdomen. The clinical picture is the same as that for acute appendicitis, and it is difficult to distinguish between them preoperatively. A case of primary torsion of the vermiform appendix is reported here along with pertinent literature review.

Explorative surgery for acute scrotal pain: The importance of patient age, side affected, time to surgery and surgeon.

Testicular torsion must be diagnosed quickly and accurately. The delay of the diagnosis and the subsequent delay of surgery may lead to loss testicular viability and orchidectomy. Aim of our retrospective evaluation was to define which element should be considered as major support to the clinician in distinguishing spermatic cord torsion from the other diseases mimicking this clinical emergency requiring surgical exploration. We retrospectively reviewed all clinical and instrumental data of emergency scrotal exploration performed for acute scrotal pain at two different Urological Department in a 10 year period. Results of surgical exploration represented the four diagnostic categories in which patients were divided for statistical evaluation. We evaluated the relationship between diagnosis performed by testicular surgical exploration and the all clinical data available including surgeon involved in the procedures. A total of 220 explorative scrotal surgery were considered. We divided the cases in 4 categories according to the diagnostic results of each surgical procedure. Of all, spermatic cord torsion was diagnosed in 45% (99/220). The total testis salvage rate was of 78.8%. The patients with a diagnosis of spermatic cord torsion were older than patients with appendix torsion (15 vs 11 years in mean). When the affected side was the left, the probability to have a diagnosis of spermatic cord torsion was higher than the right side [χ2 (2, N = 218) = 11.77, p &lt; 0.01]. Time elapsing between onset of symptoms and testicular salvagewas significantly lower even than in case of appendix torsion/necrosis (p &lt; .0001), and of others pathologies diagnosed (p = .0383). In case of spermatic cord torsion, in addition to the clinical data, patient age and left side affected may represent an independent diagnostic predicting factor. The time elapsing between onset of symptoms and explorative surgery remain the only still prognostic factor for testicular viability.

Perspectives in Pediatric Pathology, Chapter 19. Testicular Torsion, Testicular Appendix Torsion, and Other Forms of Testicular Infarction.

Among the most frequent specimens at the pediatric surgical pathology bench, orchiectomy performed after testicular torsion deserves significant attention. Multiple implications, including fertility, legal complications, possibility of occult lesion, and others, need to be considered. Furthermore, torsion of testicular and other appendices represents common urological emergencies frequently encountered in surgical pathology. Here we present a review of testicular torsion and infarction, including theories about their pathogenesis and the appropriate handling by the diagnostic pathologist.

Role of Doppler ultrasonography in acute scrotum in children and young adults

Background: Objective: To evaluate the efficacy of Doppler ultrasound in correctly diagnosing acute scrotal conditions in children and young adults. Methods: Over a period of two years 50 patients with acute scrotum were admitted in general surgery department who underwent Doppler ultrasound scrotum and its efficacy in correctly diagnosing the pathology was analysed. Results: 50 patients with age group ≤25 years were included in study. Scrotal pain was the most frequent presenting symptom of acute scrotum (98%) followed by Swelling of the hemiscrotum on the involved side present in 88% of the patients. Doppler ultrasound showed torsion of testis in 22 patients. On Scrotal exploration, torsion of spermatic cord was confirmed in 20 patients, one patient had torsion of appendix of testis and the other had Epididymo-orchitis. Thus the sensitivity and specificity of Doppler ultrasonography for testicular torsion was 86.9% and 92.6% respectively. Three patients with equivocal Doppler findings, but strong clinical suspicion of testicular torsion were explored, and testis was found to be torsed in all the three patients. Doppler ultrasonography showed Epididymo-orchitis in 20 patients, torsion of testicular appendage in 2 patients, Idiopathic scrotal edema in one, Incarcerated inguinal hernia in one, and a large hematocele in one patient. All twenty patients of epididymo-orchitis, two patients of torsion of testicular appendage, and one patient of idiopathic scrotal edema were managed conservatively. At three weeks follow up, all the patients were free of symptoms. One patient of scrotal trauma with Doppler showing a large hematocele, and the other one with obstructed inguinal hernia were explored and Doppler findings were confirmed. The sensitivity and specificity of Doppler ultrasonography for epididymo-orchitis was 95% and 100% respectively. Conclusions: Doppler ultrasound scrotum is an important investigation in acute scrotum.

Perforated Acute Appendicitis Mimicking Torsion of Appendix: A Case Report

Perforated Acute Appendicitis Mimicking Torsion of Appendix: A Case Report

Acute Scrotum: Is Scrotal Exploration the Best Management?

Selective scrotal exploration of only those boys believed to have testicular torsion (TT), relying on history and clinical examination for diagnosis, can result in a missed or delayed diagnosis of TT. To minimise testicular loss we propose early scrotal exploration in all boys with acute scrotum (AS). To validate our approach we investigated the accuracy of clinical diagnoses of all boys with AS admitted to our unit. Clinical features and diagnoses were correlated with operative findings. A retrospective review of the records of all boys (1-16 years of age) presenting with AS between 2003 and 2007 was done. Overall, 138 boys were seen during this period. Three boys were treated conservatively. The 135 boys who underwent scrotal exploration were divided into three groups: Group A (47 boys) with a history and clinical features considered preoperatively to be consistent with torsion of appendix of testis (TAT); Group B (46 boys) whose characteristics were thought to be more consistent with TT; and finally Group C (42 boys) in whom a preoperative definitive diagnosis could not be made. The preoperative clinical features and diagnoses of the 135 boys were correlated with the operative findings. In Group A, exploration confirmed TAT in 37 (78%) boys, but in 7 (15%) boys it revealed TT. In Group B, exploration confirmed torsion in 31 (68%) boys, but 13 (28%) had TAT. In Group C, exploration revealed 39 (93%) cases of TAT and 3 (7%) cases of TT. Surgical exploration in all cases of paediatric AS offers an accurate diagnosis and treatment, thus minimising the risk of testicular loss.

Die Hydatidentorsion kann einen Tumor des paratestikulären Gewebes vortäuschen

The authors present a case of testicular appendix torsion that mimicked a tumour of the paratesticular tissues due its calm clinical course, objective palpation and ultrasound finding. The torsion of the big testicular appendix was found during surgery from an inguinal approach. The histological examination confirmed only minimal inflammation changes and excluded tumour disease.

Secondary torsion of vermiform appendix

Secondary torsion of vermiform appendix

Cecal epiploica appendix torsion in a female child mimicking acute appendicitis: a case report

Acute appendicitis is the most common cause of the right lower quadrant acute abdominal pain in children. Some other conditions including cecal epiploica appendix torsion, can simulate acute abdomen. Epiploica appendix torsion usually occurs in the sigmoid colon and rarely in the cecum of adult males. In children, this entity is extremely rare and may represent a diagnostic and therapeutic dilemma. We report a case of an 8-year-old Greek girl, presented with signs and symptoms mimicking acute abdomen. Our patient is the younger one among the other four with cecal epiploica appendix torsion that had been reported in the literature.