title: Manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the feasibility and safety of manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring.
  
  
  METHODS
  Fifteen boys with torsion of an intrascrotal appendage, confirmed by scrotal ultrasonography and clinical status, were included in the study. The boys were 6 to 13 years old (mean age, 9 years). They all had painful, unilateral swelling of the scrotum and a palpable, tender nodule on physical examination. Scrotal ultrasonography indicated a single, variably echoic mass corresponding to the intrascrotal appendage. The mass was avascular according to Doppler ultrasonography. Thirteen boys underwent manual reduction under ultrasonographic monitoring. We tried to pull and release the swollen appendage in 8 patients and gently squeezed the appendage in 5. The procedure was considered successful when ultrasonography showed reperfusion in the appendage and the patients stated complete relief of scrotal pain. In 14 boys, follow-up scrotal ultrasonography was performed after the manual reduction.
  
  
  RESULTS
  Successful reduction was obtained in 12 (80.0%) of 15 boys. Only 1 boy was regarded as having reduction failure; this patient had intractable pain after the trial reduction, and ultrasonography showed transient vascular flow that promptly disappeared in the appendage. On follow-up ultrasonography, the maximal diameter +/- SD of the intrascrotal appendages significantly decreased from 6.1 +/- 1.2 to 4.0 +/- 1.3 (P=.005) in 11 patients with successful reduction.
  
  
  CONCLUSIONS
  Manual reduction under ultrasonographic monitoring seems to be a feasible and effective method for the treatment of torsion of an intrascrotal appendage to immediately relieve pain.
authors.affiliation: Department of Radiology, Soonchunhyang University Bucheon Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-021, Korea. indawn@schbc.ac.kr
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Park
authors.forename: Hae Kyung
authors.initials: HK
authors.lastname: Lee
authors.forename: Boem Ha
authors.initials: BH
authors.lastname: Yi
authors.forename: Jang Gyu
authors.initials: JG
authors.lastname: Cha
authors.forename: Joon Hee
authors.initials: JH
authors.lastname: Joh
authors.forename: Hyun Sook
authors.initials: HS
authors.lastname: Hong
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D002648:Child; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations; D012611:Scrotum / Q000000981:diagnostic imaging*; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography