Clinical context (Prepubertal boys peak 7–12 years; acute scrotal pain, often less severe than testicular torsion; blue dot sign; Doppler shows increased flow to appendix testis)
First-line therapy
Supportive care • —
Duration: Until symptoms resolve · NSAIDs, scrotal support, rest — self-limiting in most cases
Surgical exploration if diagnosis uncertain • —
Duration: Single evaluation · If cannot exclude testicular torsion — urgent urology/surgical exploration (EAU/ESPU, NICE)
Clinical notes
• Distinguish from testicular torsion — if any doubt, urgent surgical exploration within 6 h of symptom onset for torsion rule-out (EAU/ESPU).
• Doppler ultrasound: twisted appendage with hyperemia; normal or increased testicular flow.
• Antibiotics not indicated unless secondary infection — focus on analgesia and follow-up.
