[Torsion of appendix of testis and epididymis: a report of 4 cases]

Abstract

We report our clinical and pathological observations on four patients with torsion of appendix testis or epididymis, and reviewed 72 cases of torsion of the appendages of intrascrotal organs collected from the Japanese literature; 35 cases of torsion of appendix testis, 36 cases of torsion of appendix epididymis and 1 case of torsion of paradidymis . Case 1 was a 10-year-old boy visiting us because of pain and swelling in his right scrotum continuing for the past ten days. His right scrotum was found to contain a hen-egg sized tender mass. The testis and epididymis could not be differentiated by palpation. The blood count disclosed 10,000 white blood cells. At operation, two appendix epididymis were found in his right scrotum. One of them was twisted 360 degrees clockwise and 10 x 8 x 5 mm in size. Case 2 was a 11-year-old boy with complaint of pain in his left lower abdomen and left scrotum for the past three days. Palpation of his left scrotal contents revealed a slightly hard testis and tender epididymis. At operation, we found his left spermatic cord to be twisted 90 degrees counterclockwise and appendix epididymis 180 degrees counterclockwise. The twisted appendix epididymis was 10 x 8 x 7 mm in size. Case 3 was a 13-year-old boy whose complaint was left scrotal pain. The upper pole of his left testis was found to be swollen and tender by palpation. The exposure of his left scrotum at operation revealed that his left epididymis was abnormally attached to his left testis and had two appendices. One of these appendix epididymis was twisted 180 degrees clockwise and measured 10 x 10 x 8 mm. Case 4 was a 19-year-old male who suffered from right testicular pain for the past seven days. He had a history of three intermittent episodes of similar right testicular pain during the past two years. His right testis was enlarged and palpated slightly hard and tender. We explored his right scrotum surgically and found the appendix testis twisted and enlarged to little-finger's head size. However, it was impossible to determine whether the rotation was clockwise or counterclockwise because the twisted appendix was too severely damaged. The preoperative diagnosis was correct in one case and three were erroneously diagnosed as having torsion of spermatic cord. All four cases were treated by surgery which relieved all patients of discomfort.