www.elsevier.com/locate/jpedsurg

Torsion of the epididymis

Paul Brissona,*, Neil Feinsb, Haroon Patelc

aDepartment of Surgery, St. Clare’s Hospital, Schenectady, NY 12304, USAbDivision of Pediatric Surgery, Children’s Hospital, Boston, MA, USAcDriscoll Children’s Hospital, Corpus Christi, TX, USA

0022-3468/$ – see front matter D 2005

doi:10.1016/j.jpedsurg.2005.07.006

T Corresponding author. Departmen

NY 12340, USA. Tel.: +1 518 377 6429

E-mail address: pbrisson@stclares.o

Index words:Epididymis;

Torsion;

Undescended testis

Abstract Anomalies of the epididymis are most commonly associated with an undescended testis

but also found occasionally in a normally descended testis. Our 11-year-old patient presented with

an acute scrotum and Doppler ultrasound that suggested epididymitis. Painful symptoms required

scrotal exploration with the finding of a torsion and infarction of the epididymis. The etiology of the

torsion was an abnormal attachment of the epididymis to the testis. Torsion of the epididymis has not

previously been reported.

D 2005 Elsevier Inc. All rights reserved.

The epididymis is a complex structure within which

sperm undergo transport, maturation, and storage phases,

followed by release into the vas deferens during ejaculation

[1]. Structural anomalies of the epididymis are most

commonly associated with maldescent [2-4]. Anomalies

of the normally descended testis have also been reported [5].

We report here torsion of the epididymis in a boy with a

normally descended testis but with an abnormal epididymal

attachment to the testis. Torsion of the epididymis has not

previously been reported.

1. Case report

An 11-year-old boy presented to the emergency

department with a painful erythemetous left scrotum.

Symptoms began about 8 hours earlier during school.

Elsevier Inc. All rights reserved.

t of Surgery, St. Clare’s Hospital,

; fax: +1 518 377 1291.

rg (P. Brisson).

There was no history of undescended testis. There was no

associated nausea, vomiting, or abdominal pain. Physical

examination revealed an erythemetous, edemetous left

hemiscrotum with testicular tenderness. Pain was a

primary symptom. The patient underwent Doppler ultra-

sound of the scrotum, which demonstrated a diffusely

enlarged epididymis, which also appeared cystic (Fig. 1).

Increased flow to both the epididymis and testis was also

noted. Because of persistent painful symptoms, the patient

underwent scrotal exploration. The epididymis was found

to be torsed, edemetous, and infarcted (Fig. 2). The

epididymal attachment to the testis was normal at the head

but the body and tail of the epididymis were found to be

free and unattached (Fig. 3). We excised the infarcted

epididymis and ligated the vas deferens. There were no

postoperative complications.

2. Discussion

Most commonly, the normal anatomy of the epididymis

demonstrates the epididymal head to be firmly attached to

Journal of Pediatric Surgery (2005) 40, 1795–1797

Fig. 1 Scrotal ultrasound. A, Cystic appearing epididymis. B,

Normal appearing testis.

ig. 3 Abnormal attachment of the epididymis to the testis.

ead is attached but the body and tail are unattached.

P. Brisson et al.1796

the upper pole of the testis by the efferent ductules. The

tail of the epididymis is closely opposed to the lower pole

with a fibrous attachment. The epididymal body is separate

from the testis and may admit the tip of the finger into the

fossa. The epididymal body can be drawn away from the

testis for a distance of about half the width of the testis

Fig. 2 Torsion of the epid

FH

[5,6]. Several classifications of epididymal anatomic

variations have been proposed. Health et al [3] described

5 variations of epididymal anatomy in 132 maldescended

testes. Turek et al [5] described 6 epididymal variations

that were identified in a review of 112 normally descended

testes, including the variation described in our patient.

Kroovand and Perlmutter [7] described 8 congenital

structural abnormalities of the epididymis.

The epididymal anomaly identified in our patient was a

normal attachment of the epididymal head without attach-

idymis with infarction.

Torsion of the epididymis 1797

ment of the body and tail. This variation has been described

in both normal and maldescended testes [3,5,6]. We feel that

the short attachment of the epididymis to the testis

predisposed the epididymis to torsion.

References

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