Torsion of the Testicular Appendices and Epididymis Treatment & Management

Updated: Feb 02, 2022
  • Author: Jason S Chang, MD; Chief Editor: Erik D Schraga, MD  more...
  • Print
Treatment

Emergency Department Care

Testicular torsion is an important and critical issue in patients with acute scrotum presenting to the ED. Early detection is very important for saving the testicles. A prospective cross-sectional study concluded that clinical variables are not accurate enough to be considered as the sole predictor of testicular torsion; they should be used with caution and in combination with other available screening tools such as Doppler ultrasonography. [25]

If the diagnosis is unclear and testicular torsion cannot be ruled out, or if pain persists, surgical exploration is warranted. [7]

Necrotic tissue in the testicular appendix causes no damage other than damage to itself. Most cases, therefore, are treated conservatively. Pain usually resolves within 1 week but may persist for several weeks. Uncontrolled pain can be relieved by surgical excision of the appendix.

NSAIDs and ice are the mainstays of therapy for inflammation, and reduced activity and scrotal support are indicated.

If the diagnosis is unclear and testicular torsion cannot be ruled out or if pain persists, surgical exploration is warranted. [7]