Appendix Testis Torsion in Young Male with Retractile Testis and Absence Blood Flow in Color Doppler Ultrasound – A Case Report
Szu-Ying Pan, Po-Jen Hsiao, Chi-Ping Huang, Chao-Hsiang Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Introduction: Acute scrotum is a urological emergency requiring prompt management. Differential diagnoses include testicular torsion, torsion of the appendix testis or infection. Among these, distinguish between testicular torsion and torsion of the appendix testis is vital. Due to their similar symptoms and occurrence of age, color Doppler ultrasound is inevitably plays important role in making correct diagnosis. Besides, existence of retractile testis even increases the difficulty in performing image survey. We reported a case: appendix testis torsion in young male with retractile testis and absence blood flow in color Doppler ultrasound.
Case presentation: This is a 9 years old boy without systematic disease who was admitted via ER due to acute right scrotal pain. A sudden pain attack while he sat in the classroom taking lecture 5 hours before visiting ER. Where physical examination founded bilateral high riding testis up to inguinal, right scrotum with no swelling, no redness, no hardness but tenderness(VAS:6-8). Bedside sonography showed bilateral preserved blood flow. However, the symptoms persisted, following color Doppler ultrasound showed right no testicular blood flow. Under the impression of testicular torsion, emergent operation was arranged.
OP finding: 1. Bilateral retractile testis. 2.Right testicular normal, swelling epididymis, appendix ischemia change. 3.Left testicular: normal testis, epididymis and appendix. Bilateral orchiopexy was done smoothly.
Conclusion: Torsion of the appendix testis mimics testicular torsion in many ways. Retractile testis makes it more difficult making correct different diagnosis between testicular torsion and torsion of the appendix testis. Scrotal Exploration is still golden standard.