Testicular Appendage Torsion in Children

Testicular appendage torsion is the twisting of a small piece of tissue above a testicle. The appendage doesn’t have a function in the body. But it can twist and cause pain and swelling that gets worse over time. It is not the same as testicular torsion. It is not a medical emergency.

Side view of testicle showing testicular appendage.
Normal testicular appendage

Side view of testicle showing twisted testicular appendage.
Testicular appendage torsion

What causes testicular appendage torsion?

Appendage torsion can happen at any time. It’s most likely to happen during sleep. When the appendage gets twisted, it cuts off its own blood supply. This doesn’t cause any serious damage. Boys who haven’t yet reached puberty are most at risk.

Is it the same as testicular torsion?

Testicular appendage torsion is not the same thing as testicular torsion. Testicular torsion is the twisting of the testicle. This is a medical emergency. The torsion causes a loss of blood supply to the testicle. Surgery is needed right away to prevent lasting (permanent) damage. The symptoms can be similar in both conditions. But the pain of testicular torsion is often more severe.

Symptoms of testicular appendage torsion

Symptoms can include:

  • Pain in one testicle, on one side of the scrotum

  • Swelling and redness of the scrotum

  • Scrotum that’s sore to the touch

  • A hard lump at the top or bottom of the testicle

  • A blue dot at the top of the scrotum showing the twist is in the appendage, not the testicle

How is testicular appendage torsion diagnosed?

Your child’s healthcare provider will ask about his health history and symptoms. He will be given a physical exam. He may also have tests such as:

  • Urine test to check for other possible causes of scrotal pain such as infection

  • Imaging test of the child's scrotum, such as ultrasound

In some cases, your child may need surgery right away if it seems your child may have testicular torsion. This is to help prevent severe problems. During surgery, the healthcare provider will be able to see if the condition is testicular appendage torsion.

Treatment for testicular appendage torsion

Treatment for testicular appendage torsion includes:

  • Rest

  • Raising the area to help ease swelling

  • Over-the-counter pain medicine

When to call the healthcare provider

Call the healthcare provider if your child’s symptoms don’t get better, or get worse.

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