Medical expert of the article
New publications
Torsion of the testicular hydatid and testicular appendage
Last reviewed: 12.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Torsion of the hydatids of the testicle occurs as a result of acute, subacute and chronic circulatory disorders that occur as a result of torsion or microtrauma of the epididymis. Hydatids of the testicle and epididymis (Greek hydatidos - water bubble) are rudiments of the Müllerian ducts, which are a cystic expansion of additional formations of the testicle, consisting of individual lobes and containing convoluted tubules associated with the testicle and epididymis or located on a stalk.
Hydatids are formed in the process of reverse development of the Müllerian ducts during their incomplete reduction during sexual development and represent a remnant of the Wolffian duct.
What causes torsion of the hydatid testicle and its epididymis?
Torsion of the hydatid testicle occurs in the presence of a long or narrow stalk. The development of pathological changes in the hydatid is facilitated by the main type of blood circulation, loose and delicate stroma of the organ with the absence of elastic fibers. According to the clinical and morphological study, torsion of the hydatid stalk is detected in a small number of cases. More common is a violation of the blood circulation of the hydatid or its inflammation. Such changes occur as a result of bending of the hydatid stalk, torsion with spontaneous untwisting, venous outflow disorders during physical exertion or scrotal injuries.
Symptoms of testicular hydatid torsion
Torsion of the hydatid testicle is characterized by the appearance of pain in the area of the testicle, inguinal canal and, less often, pain in the abdominal area radiating to the lumbar region. On the first day, a dense, painful infiltrate is determined in the area of the upper pole of the testicle or the area of the epididymis. Edema and hyperemia appear later, which is associated with the progression of the pathological process. Patients note compaction and enlargement of the testicle. The infiltrate is palpated depending on the location of the hydatid.
It should be noted that the localization of clinical manifestations of damage to the suspensory develops slowly and is not always pronounced if the damage has been going on for a long time. In the area of the testicle or appendage, a "blue dot" symptom is noted, which corresponds to the localization of the twisted hydatid (a painful seal shines through the skin of the scrotum in the form of a dark blue node). This symptom can be detected in the first 24 hours of the disease.
Children with testicular hydatid torsion often experience nausea and vomiting, and the late stage of the disease is accompanied by an increase in temperature to subfebrile values. The peak of the disease is characterized by hyperemia and increasing swelling of the scrotum. During this period, the testicle and appendage are not differentiated.
Thus, the main symptoms of testicular hydatid torsion are:
- sudden onset of testicular pain;
- moderate asymmetric swelling and hyperemia of the scrotum;
- presence of dense infiltrate.
Diagnosis of testicular hydatid torsion
The diagnosis of testicular hydatid torsion is based on knowledge of the clinical picture, as well as the concomitant disease, which in some cases can simulate a pathological process in the testicle, and therefore lead to an incorrect treatment method in situations where the clinical picture is unclear. In addition to general clinical methods, the following studies are carried out:
- inspection;
- transillumination (examination of the scrotum using transmitted light);
- ultrasound echography.
[ Clinical diagnosis of testicular hydatid torsion
Palpation of the hydatid is impossible.
Instrumental diagnostics of testicular hydatid torsion
Diaphanoscopy of the scrotum allows detection of dark-colored formations in the area of typical localization of hydatids.
During ultrasound, hydatid is defined as a protrusion or tubercle measuring 2-5 mm, most often at the upper pole of the testicle or in the groove between the testicle and the head of its appendage. There may be several such formations, but they are sometimes not identified echographically, since their delicate structure is not always differentiated from the surrounding tissues. They are best visualized with hydrocele and are found in 80-95% of men.
Differential diagnosis of testicular hydatid torsion
Torsion of the hydatid testicle must be distinguished from acute orchitis, which is relatively rare in children, has similar clinical symptoms, but requires different treatment.
What do need to examine?
Who to contact?
Treatment of testicular hydatid torsion
Non-drug treatment of testicular hydatid torsion
Conservative treatment of testicular hydatid torsion is carried out only in cases of mild clinical manifestations and a tendency for the disease to regress within the next 24 hours.
Surgical treatment of testicular hydatid torsion
Emergency surgeries for acute scrotum syndrome are the second most common after appendectomies in children. During revision of the scrotum organs, pathological changes in the appendages of the testicle or appendix are detected in 60-90% of cases, which is considered to be torsion of its pedicle.
Most authors believe that in case of torsion of the testicular appendages, emergency surgery is necessary, which helps prevent the development of complications such as:
- chronic hydrocele of the testicle, the long-term existence of which adversely affects the blood and lymph circulation and function of the testicle, which can lead to its atrophy;
- secondary non-specific epididymitis, epididymo-orchitis, contributing to obstruction of the vas deferens and the development of infertility;
- dysfunction of a healthy testicle and its atrophy.
Technique of surgery for testicular hydatid torsion
All layers of the scrotum wall are dissected through the inguinal approach, all membranes of the testicle are opened. When the serous cavity is opened, a small amount of light hemorrhagic or turbid exudate is released, which is sent for bacteriological examination. The testicle is unchanged in most cases. Most often, an increase in the head and body of the epididymis is observed. In the area of the upper pole of the testicle or the head of its epididymis, a hydatid is found and brought out into the wound. The affected hydatid is enlarged. Sometimes it is even larger than the testicle, dark purple or black in color. Only the epididymis with a long and thin stalk is twisted.
Torsion of the testicular hydatid may be either clockwise or counterclockwise. The hydatid is resected with a section of the unchanged part to prevent progression of vaginitis. Unchanged hydatids are also removed. A blockade of the spermatic cord is performed with 10-15 ml of 0.25-0.5% procaine (novocaine) solution with antibiotics (in case of cloudy effusion or vaginitis). The defect of the parietal layer of the tunica vaginalis of the testicle is sutured. A rubber drain or drainage tube is inserted into the scrotal cavity and sutures are applied to the skin. Without suturing the tunica vaginalis of the testicle, according to Ya.B. Yudin et al. (1987), the testicle fuses with the postoperative scar, which is subsequently accompanied by its trauma (with trauma to the muscle supporting it) and contributes to the development of fibrosis. The Winkelmann operation is not indicated, since the removal of hydatids, including unchanged ones, eliminates the conditions for the further development of hydrocele.
Further management
In the postoperative period, anti-inflammatory treatment is prescribed.