What is the treatment for Appendix Testis Torsion?

Treatment for Appendix Testis Torsion

Conservative management is the recommended treatment for appendix testis torsion, which includes rest, scrotal elevation, and pain management with non-steroidal anti-inflammatory drugs. 1

Diagnosis and Differentiation

Proper diagnosis is crucial to differentiate appendix testis torsion from testicular torsion, as their treatments differ significantly:

• Appendix Testis Torsion:

  • Often presents with gradual onset of pain
  • May show the "blue dot sign" (tender nodule with blue discoloration on the upper pole of the testis) 1
  • Ultrasound shows an enlarged, homogeneously echogenic appendix testis medial or posterior to the head of the epididymis 2
  • Doppler ultrasound shows normal or increased testicular blood flow

• Testicular Torsion:

  • Sudden onset of severe pain
  • Absent cremasteric reflex (most accurate sign)
  • High-riding testis
  • Doppler ultrasound shows decreased or absent blood flow 3

Treatment Algorithm

1. Confirm diagnosis with ultrasound

   • Scrotal ultrasound with Doppler is the recommended initial imaging for acute scrotal pain 4
   • Look for an enlarged, echogenic appendix testis with normal testicular blood flow 2

2. Conservative management (first-line treatment)

   • Bed rest until local inflammation subsides
   • Scrotal elevation to reduce edema and pain
   • NSAIDs for pain management 3, 1
   • Most cases resolve within 5-7 days with conservative treatment

3. Surgical intervention (optional)

   • While not mandatory, surgical removal of the twisted appendix testis can hasten recovery 1
   • Consider surgery if:
     • Symptoms are severe and not responding to conservative management
     • Diagnosis is uncertain and testicular torsion cannot be ruled out

Important Considerations

• Urgent differentiation from testicular torsion is critical

  • Testicular torsion requires emergency surgical intervention within 6 hours to save the testis
  • Appendix testis torsion can be managed conservatively 1

• Ultrasound findings

  • Hydrocele and thickening of the scrotal wall are common accompanying findings
  • Enlargement of the head of the epididymis may be seen
  • Scanning in coronal and transverse planes above the testis helps locate the enlarged, twisted appendix 2

• Rare associations

  • In extremely rare cases, simultaneous testicular and appendix testis torsion can occur 5
  • Torsion of the appendix testis can occur in undescended testicles, though this is exceptionally rare 6

Follow-up

• Symptoms should improve within several days of conservative management
• If symptoms worsen or do not improve, reassessment is necessary to rule out other conditions
• No specific follow-up imaging is required if symptoms resolve completely

Remember that while appendix testis torsion is painful, it does not pose a risk to testicular viability and fertility, unlike testicular torsion, which is a true surgical emergency.