Testicular appendage torsion resulting in testicular ischemia and necrosis in a child

Abstract Torsion of intrascrotal appendages is the most common cause of acute scrotum in children, comprising 40 %–60% of the underlying cause of this entity. Torsion of the testicular appendages can be managed conservatively because it spontaneously necroses, disappears, and does not cause testicular dysfunction without blocking testicular blood flow. Our patient had a relatively large torsed testicular appendage, and we performed conservative treatment because there was no spermatic cord torsion. Clear blood flow to the testis was confirmed by ultrasonography examination, but the testicular blood flow was blocked and, as a result, there was testicular necrosis. The aim of this case report is to warn that testicular necrosis can occur even in torsed testicular appendage, which presents conventional ultrasonic findings and can rule out torsion of the spermatic cord.