The testicular appendix is an embryologic remnant on the anterosuperior aspect of the testes of approximately 3 mm in diameter that fails to fully regress. Torsion of the testicular appendage refers to a twisting of this remnant appendage that results in sudden-onset, unilateral scrotal pain, inflammation, erythema, and tenderness of the testicular appendage without testicular tenderness. It occurs spontaneously, most commonly in boys aged 7-12. Patients will have preservation of the cremasteric reflex and a nontender testicle, although this can be difficult to differentiate due to often extreme tenderness of the adjacent testicular appendage.
Management is typically noninvasive, including analgesia, bed rest, and scrotal support.
Excluding alternative etiologies that may warrant more expedited emergency attention (eg, testicular torsion) is of paramount importance.
Torsion of appendix of testis
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Codes
ICD10CM:
N44.03 – Torsion of appendix testis
SNOMEDCT:
198047009 – Torsion of appendix of testis
N44.03 – Torsion of appendix testis
SNOMEDCT:
198047009 – Torsion of appendix of testis
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Differential Diagnosis & Pitfalls
Torsion of the testicular appendage is a benign, although painful, condition. It is most important to exclude other conditions that can present similarly in some circumstances.
- Testicular torsion – Cremasteric reflex can be absent; will have testicular tenderness. This is a surgical emergency.
- Acute appendicitis – Typically with anorexia and right lower quadrant abdominal pain that will migrate towards the umbilicus, but patients with a retrocecal appendix can present with inguinal / testicular pain.
- Inguinal hernia with incarceration – Surgical emergency if not reducible.
- Testicular trauma
- Hydrocele
- Epididymo-orchitis
- Immunoglobulin A vasculitis (Henoch-Schönlein purpura)
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Last Reviewed:04/14/2019
Last Updated:10/10/2022
Last Updated:10/10/2022