Torsion of testicular appendages can result in the clinical presentation of acute scrotum. Two such appendages are the appendix testis, a remnant of the paramesonephric (müllerian) duct, and the appendix epididymis, a remnant of the mesonephric (wolffian) duct.
The appendix testis is present in 92% of all testes and is usually located at the superior testicular pole in the groove between the testicle and the epididymis. The appendix epididymis is present in 23% of testes and usually projects from the head of the epididymis, but its location may vary. Most acute presentations of scrotal pain and swelling can be attributed to epididymitis, testicular torsion, or torsion of a testicular appendage. The presentations of these conditions can typically be distinguished by history and examination. However, in many cases, torsion of a testicular appendage, although a benign condition, may present identically to testicular torsion, a true urologic emergency.
Testicular torsion must be diagnosed quickly and accurately, because delay of the diagnosis and subsequent delay of surgery, if needed, can lead to loss of testicular viability and orchidectomy.