Torsion of testicular gidatids and its epididymis

Torsion of testicular hydatids occurs as a result of acute, subacute and chronic circulatory disorders, resulting from a torsion or microtraumatic epididymis. The testicles of the testicle and appendage (Greek hydatidos water bubble) are rudiments of the Mullerian ducts, representing a racemose widening of the additional testicle formations, consisting of individual lobules and containing convoluted tubules associated with the testicle and appendage or located on the stem.

Hydatids are formed in the process of reverse development of Mullerian ducts with their incomplete reduction during sexual development, represent the remainder of the Wolf channel.

What causes a torsion of the testis and its epididymis?

Torsion of testicular hydatids occurs when there is a long or narrow leg. The development of pathological changes in hydatide is facilitated by the main type of circulation, loose and tender stroma of the organ with no elastic fibers. According to the clinical and morphological study, the torsion of the legs of the hydatid is detected in a small number of cases. More often there is a violation of the circulation of the hydatid or its inflammation. Such changes occur as a result of kinks of the hydatida leg, torsion with spontaneous untwisting. Disorders of venous outflow during physical exertion or scrotal injury.

Symptoms of tester hydatid torsion

Torsion of testicular hydatids is characterized by the appearance of pain in the testicle, inguinal canal and rarely pain in the abdomen with irradiation into the lumbar region. The first day is determined by a dense, painful infiltration in the region of the upper pole of the testicle or the appendage region. Edema and hyperemia occur later, which is associated with the progression of the pathological process. In patients, the densification and enlargement of the testicle is noted. The infiltrate is palpated depending on the location of the hydatida.

It should be noted that the localization of clinical manifestations of hinge damage develops slowly and with a long term of injury is not always pronounced. In the area of the testicle or appendage, a symptom of the "blue dot" is noted, which corresponds to the localization of a twisted hydatide (a painful seal shines through the skin of the scrotum in the form of a node of a dark-cyanotic color). This symptom can be caught in the first 24 hours of the disease.

Often in children with torsion of testicular hydatids, nausea and vomiting appear, and the late stage of the disease is accompanied by an increase in temperature to subfebrile values. The height of the disease is characterized by hyperemia and an increasing swelling of the scrotum. In this period the testicle and appendage do not differentiate.

Thus, the main symptoms of torsion of testicular hydatids are:

• sudden onset of pain in the testicle;
• mild asymmetric edema and congestion of the scrotum;
• presence of a dense infiltrate.

Diagnosis of torsion of testicular hydatids

Diagnosis of torsion of testicular hydatids is based on the knowledge of the clinical picture, as well as the concomitant disease, which in some cases can simulate the pathological process in the testicle and, consequently, lead to the wrong method of treatment in situations where the clinical picture is unclear, in addition to general clinical methods, carry out such studies as :

• inspection;
• transillumination (examination of the scrotum in transmitted light);
• ultrasound echography.

[1], [2], [3], [4]

Clinical diagnosis of torsion of testicular hydatids

Palpation gidatida impossible.

[5], [6], [7], [8], [9], [10], [11]

Instrumental diagnostics of torsion of testicular hydatids

Diaphanoscopy of the scrotum allows to detect the formation of a dark color in the region of typical localization of hydatids.

In ultrasound, the hydatid is defined as a protuberance or tubercle 2-5 mm in size, more often at the upper pole of the testicle or in the furrow between the testicle and the head of its appendage. There may be several such formations, but they are sometimes not recognized echographically, since their tender structure does not always differentiate from surrounding tissues. They are best visualized with hydrocele and are found in 80-95% of men.

Differential diagnosis of torsion of testicular hydatids

Torsion of testicular hydatids must be distinguished from acute orchitis, which is relatively rare in children, has similar clinical symptoms, but requires other treatment.

[12], [13], [14]

Treatment of titanium testatine torsion

Non-drug treatment of titanium hydatide torsion

Conservative treatment of torsion of testicular hydatids is carried out only with mildly expressed clinical manifestations and a tendency to regress of the disease in the next 24 hours.

Operative treatment of torsion of testicular hydatids

Emergency operations for the syndrome of the "acute scrotum" are second in frequency after appendectomy in children. In the revision of the scrotum organs, 60-90% of the observations reveal pathological changes in the epididymis or epididymis, which is regarded as a torsion of her legs.

Most authors believe that with the twisting of the epididymis, an urgent operation is necessary, which helps prevent the development of complications such as:

• chronic edema of the testicle, the prolonged existence of which adversely affects blood and lymph circulation and testicular function, which can lead to its atrophy;
• secondary nonspecific epididymitis, zpididemoorhit, contributing to obstruction of the vas deferens and development of infertility;
• a violation of healthy testicle function and its atrophy.

Technique for the operation of torsion of testicular hydatids

Inguinal access is dissected by all layers of the scrotal wall that open all the shells of the testicle. When the serous cavity is opened, a small amount of light hemorrhagic or turbid effusion is released, which is sent for bacteriological examination. The testicle in most cases is not changed. The increase in the head and body of the epididymis is more common. In the region of the upper pole of the testicle or the head of its appendage find the hydatid and remove it into the wound. The affected hydatid is increased. Sometimes it is even bigger than a testicle of a dark purple or black color. Twisted only epididymis with a long and thin stem.

Torsion of testicular gidatides can be both clockwise and in the opposite direction. The hydatid is resected with a portion of the unchanged part to prevent the progression of vaginitis. Removed also unmodified hydatids. Conduct a blockade of the spermatic cord 10-15 ml of 0.25-0.5% solution of procaine (novocaine) with antibiotics (with turbid effusion or vaginitis). Defect of the parietal leaf of the vaginal sheath of the testicle is sutured. In the cavity of the scrotum, a rubber graduate or drainage tube is inserted and seams are applied to the skin. Without suturing the vaginal shell of the testicle, according to Ya.B. Yudin et al. (1987), the testicle is soldered with a postoperative scar, which is subsequently accompanied by traumatization (with traumatization of the supporting muscle) and promotes the development of fibrosis. Operation Winckelmann is not shown, since the removal of hydatids, including unmodified, eliminates the conditions for the further development of hydrocele.

Further management

In the postoperative period, an anti-inflammatory treatment is prescribed.

Forecast torsion of testicular hydatids

Torsion of testicular hydatids have a favorable prognosis after surgery for the defeat of the hydatida.

[15], [16], [17], [18]