The most common testicular appendage susceptible to torsion is the appendix testis, which is a remnant of the Mullerian duct. Presentation is usually the same as that for testicular torsion. Patients are most often adolescents and present with the sudden onset of orchalgia. Occasionally, early in the course of the process, before edema has developed, it is possible to palpate the twisted appendage as a small (3- to 5-mm) tender area or mass close to the upper pole of the testis. Also, rarely, a blue dot sign maybe seen through the skin of the scrotum, corresponding to a torsed, ischemic testicular appendage. As time passes, edema develops, thus making physical examination impossible, which usually requires an ultrasound examination to evaluate whether testicular torsion is present.
Management, if the diagnosis is certain, consists of supportive care, with the liberal use of analgesic, in the form of anti-inflammatory medications. If diagnosis is uncertain, meaning that testicular torsion is suspected, then exploration is mandatory (Fig. 12.5).
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