Editing Acute Scrotum (section)

==Torsion of the Appendix Testis and Epididymis==

=== Background ===

*Appendix testis
**From the müllerian duct
**Present in 76-83% of testes
*Appendix epididymis
**From the wolffian duct
**Present in 22-28% of testes

=== Epidemiology ===

*'''Peak age at occurrence is 7-12 years'''

=== Diagnosis and Evaluation ===
*'''<span style="color:#ff0000">History and Physical Exam'''
**'''<span style="color:#ff0000">Physical Exam'''
***'''<span style="color:#ff0000">“Blue dot sign”: a discoloration at the upper pole of the testis representing the ischemic appendage, may be seen through stretched scrotal skin'''
*'''Imaging'''
**'''US'''
***'''Rarely demonstrates an abnormal appendage'''
****The normal appendix testis contains no internal blood flow, whereas the twisted appendage may appear as an ovoid hyperechoic, hypoechoic, or heterogeneous nodule without blood flow
***'''Commonly shows hyperperfusion of the epididymis.'''

=== Management ===
*'''<span style="color:#ff0000">Observation'''
**Torsion of an appendage is a self-limited process; surgery is rarely indicated