Hydatide torsion

from Wikipedia, the free encyclopedia
Classification according to ICD-10
N44.1 Hydatide torsion
ICD-10 online (WHO version 2019)

The hydatid torsion is a twist of the stem , twisting of a Morgagni hydatid around its own longitudinal axis with constriction of the blood vessels and ischemia up to necrosis and the clinical picture of an acute scrotum . The term is used as a collective term for various rudimentary appendages on the testes and epididymis , mostly it is the appendix testis Morgagni at the upper testicular pole.

Spread and cause

Hydate torsion is one of the most common causes of acute scrotum and the most common in children. The disease can occur at any age, especially in small children, preferably between the ages of 7 and 12 or between the ages of 4 and 10

Of the possible appendages (appendix testis, appendix epididymidis, paradidymis or a vas aberrans), the Morgagni hydatids twist most frequently at the upper testicular pole, especially if the vascular pedicle is long.

Clinical manifestations

Clinical criteria are:

  • Sudden onset of pain in a testicular compartment, varying in extent, from minor to full picture, such as with a testicular torsion
  • Initially, a pain-sensitive lump can be felt at the upper testicle pole if the testicle itself is painless
  • the torqued hydatide can be visible externally with a bluish shimmer (blue dot sign)
  • in the course redness, swelling and a hydrocele testis develop
  • no nausea and vomiting (as with testicular torsion)
  • no dysuria or pyuria (as in epididymitis )

diagnosis

The hydatide can be detected sonographically .

Differential diagnostics

The testicular torsion is mainly to be distinguished as an emergency . This is the color-coded Doppler sonography with measuring the resistance index (RI) method of choice. There are doubts about the methodological reliability of the exclusion.

Further differential diagnoses are:

treatment

If the diagnosis is certain, no operation is necessary. Conservative measures such as bed rest, cooling, and anti-inflammatory drugs are usually sufficient.

If the symptoms do not subside within 1–2 days, the hydatides are removed.

If there are only minor uncertainties about the exclusion of testicular torsion or if the symptoms are pronounced, surgical removal takes place.

Individual evidence

  1. ↑ a b c Marcel Bettex (ed.), Max Grob (introduction), D. Berger (arrangement), N. Genton, M. Stockmann: Pediatric Surgery. Diagnostics, indication, therapy, prognosis. 2nd, revised edition, p. 8.2010, Thieme, Stuttgart / New York 1982, ISBN 3-13-338102-4
  2. ↑ a b c P. Günther, I. Rübben: Acute scrotum in childhood and adolescence. In: Deutsches Aerzteblatt Online. 2012, doi: 10.3238 / arztebl.2012.0449 .
  3. ↑ D. Manski: Urology textbook
  4. ↑ Entry on hydrate torsion in the Flexikon , a Wiki of the DocCheck company
  5. ↑ a b c d Torsion and its therapy on Medscape
  6. ↑ a b J. W. Thüroff, H. Schulte-Wissermann (editor): Pediatric urology in clinic and practice. , 2nd edition 2000, p. 638, Thieme, ISBN 3-13-674802-6
  7. ^ R. Fisher, J. Walker: The acute pediatric scrotum. In: British journal of hospital medicine. Volume 51, Number 6, 1994 Mar 16-Apr 5, pp. 290-292, PMID 8032565 (Review).
  8. ^ A b L. Spitz, AG Coran (Editors) Rob & Smith's Operative Surgery. Pediatric Surgery, 5th Edition 1995, pp. 735, Chapman & Hall, ISBN 0-412-59110-3
  9. ↑ a b c d e f AWMF - guidelines of the German Society for Pediatric Surgery and the German Society for Urology: "Acute Scrotum in Children and Adolescents"
  10. ^ ME Sellars, PS Sidhu: Ultrasound appearances of the testicular appendages: pictorial review. In: European radiology. Volume 13, Number 1, January 2003, pp. 127-135, doi: 10.1007 / s00330-002-1387-1 , PMID 12541120 .
  11. ↑ G. Zöller, A. Kugler, RH Ringert: “False-positive” testicular perfusion in testicular torsion in power Doppler sonography. In: The Urologist. Ed. A. Volume 39, number 3, May 2000, pp. 251-253, doi: 10.1007 / s001200050351 , PMID 10872251 .
  12. ↑ BM Altin Kilic, HD Nöske, J. Miller, W. Weidner: [Clinical aspects of hydatid twist. Diagnosis and therapy in 104 consecutive patients]. In: The Urologist. Ed. A. Volume 38, Number 4, July 1999, pp. 353-357, doi: 10.1007 / s001200050297 , PMID 10444794 .