Acute appendicitis may mask rare surgical emergencies. Torsion of an intra-abdominal undescended testis with malignancy is exceptionally uncommon. A 27-year-old man presented with 3 days of right lower quadrant pain, vomiting, and anorexia. Examination showed peritonitis and an absent right testis. Laparotomy for presumed appendicitis revealed a normal appendix and an 11 × 13 × 12 cm intra-abdominal mass with a 540° torsed spermatic cord. Right radical orchiectomy was performed. Histopathology confirmed classical seminoma. Final stage was pT2N0M0S0 Stage IB. Giant torsed seminoma can mimic appendicitis; genital examination is essential.

Amyand's hernia defined as the presence of the appendix within an inguinal hernia sac, is rare in neonates and can deteriorate quickly. We report a preterm male twin (33 + 6 weeks; 1460 g) presenting at 1 month with 24 hours of progressive right inguinoscrotal swelling, erythema, irritability, and absent stooling. Exam showed a tender, nonreducible, non-transilluminating mass with abdominal distension. X-ray revealed dilated bowel loops; ultrasound suggested an indirect right inguinal hernia containing an inflamed appendix. Urgent inguinal exploration found incarcerated viable cecum and a gangrenous appendix. Appendectomy through the same incision with high sac ligation and posterior wall repair (no mesh) was performed. Recovery was uneventful: feeds resumed, weight gain continued, and the ipsilateral testis remained viable. This Type 2 Amyand's hernia shows localized vascular compromise of the appendix in preterm infants and supports immediate targeted ultrasound and prompt surgery to avert perforation, sepsis, and gonadal injury.

Torsion of the testicular appendages is considered to be the most common cause of acute scrotal pain in prepubertal children and may even be the single most prevalent cause of pediatric orchalgia.[1] It should, therefore, be included in the differential for any male presenting with an acute scrotum but especially in the pediatric age group.[1] There are two testicular appendages that can twist and become symptomatic: the appendix testis and the appendix epididymis.  The appendix testis, sometimes called hydatid of Morgagni, is a vestigial remnant of the Mullerian duct and is present in 76% to 83% of testes.[2] When present, it is located on the superior pole of the testicle between the testis and epididymis and is the most common testicular appendage to undergo torsion. It is homologous to the fimbriated end of the Fallopian tube in the female. The appendix epididymis is a vestigial Wolffian (mesonephric) duct remnant and is present in 22% to 28% of testes.[2] When present, it occurs along the head of the epididymis. It is sometimes considered to be a detached efferent epididymal duct.

In male decapods, such as the Norway lobster Nephrops norvegicus, sexual maturity is not easily determined by macroscopic examination of gonads and few studies have been conducted on this topic. Sexual maturity is linked to changes in both external morphology and physiology. This study analyzed the maturity of N. norvegicus males in the Central-Western Mediterranean Sea (Sardinia), focusing on primary sexual characteristics (testes and vasa deferentia) and morphometric traits (appendix masculina and petasma). Since the testes showed no macroscopic changes in size during ontogeny, histological analysis was performed. It revealed that spermatogenesis occurred year-round in the Sardinian population, with the smallest mature individual at 18.3 mm carapace length (CL). All individuals above 23.5 mm CL had testes and vasa deferentia filled with spermatozoa and were considered physiologically mature. Morphometric maturity was observed between 27.7 and 36.2 mm CL, based on appendix masculina and petasma measurements. Despite a close association, secondary sexual characteristic development and physiological maturity were not synchronized, as seen in other crustaceans. This discrepancy likely reflects differences in male reproductive strategies, as males may produce spermatophores at smaller sizes (e.g., 23.5 mm CL), though there is no evidence that such males can successfully inseminate females in the wild.

Polyorchidism, or supernumerary testes (SNTs), is a rare congenital condition, management of which remains debated, particularly in paediatric cases with other concomitant features. We report a case of intrascrotal polyorchidism in a 14-year-old boy managed surgically due to parental preference and the need for histological confirmation. The patient presented with a 2-week history of painless heaviness in the scrotum. Physical examination and Doppler ultrasonography revealed a 1.8 cm mass fused to the inferior pole of the left testicle with associated Grade 1 varicocele, hydrocele and testicular appendix. Although MRI of the scrotum was initially offered, the family declined in favour of timely histological confirmation. Surgical exploration confirmed a fused supernumerary testicle and a biopsy showed normal spermatogenesis; this was consistent with Type A3 triorchidism. The patient had no complications or recurrence of symptoms at 12-month follow-up. This case highlights the use of surgical exploration in selected intrascrotal polyorchidism cases where imaging can be inconclusive or histological confirmation is required. Parental concerns and long-term reassurance may also reasonably influence management decisions.

An inguinal hernia is a common surgical condition in which abdominal contents protrude through the lower abdominal wall into the inguinal canal. The hernia sac can contain various structures, including the appendix, which, when present, is referred to as Amyand's hernia. The condition is rare, with a normal appendix found in less than 1% of inguinal hernias. This condition was first described by Claudius Amyand in 1735. The coexistence of the appendix and a testis (either undescended or retractile) within the hernia sac is a rare phenomenon, adding to the complexity of diagnosis and management. In this report, we have a one-year-old male infant presenting with a right-sided irreducible inguinal hernia associated with swelling and pain for four hours. Physical examination and ultrasound suggested an irreducible hernia with omentum as the content, but without evidence of appendix or testis involvement. On surgical exploration, a normal appendix and a retractile right testis were found within the hernial sac. The hernia contents were reduced, and a right inguinal herniotomy was performed. Intraoperative and postoperative periods were uneventful. The patient was discharged after three days and had an unremarkable follow-up. Amyand's hernia is an uncommon condition in which the appendix is located within the inguinal hernia sac. The presence of both the appendix and a testis in the same sac is even rarer. Our case differs from the classic presentation of Amyand's triad, as it involves a retractile testis and a normal appendix. This highlights the need for thorough clinical evaluation and tailored treatment based on individual findings. Surgeons should be aware of the varied presentations of this condition and the recommended management strategies to provide optimal care.

Scrotal calculi are uncommon, benign stones that typically form within the hydrocele sac, often due to chronic inflammation, minor trauma, or torsion of the appendix testis, and are incidentally detected during imaging or surgery. Although rare, scrotal calculi have been reported to occur in specific groups, such as athletes, who experience repetitive mechanical stress. A 56-year-old diabetic male presented with a two-year history of painless scrotal swelling. The swelling is not associated with any trauma. On physical examination, the swelling transilluminated, and an ultrasound revealed an 8-cm hydrocele with a 1.4-cm free-floating lesion, which was isoechoic to the surrounding tissue. The testes and epididymis appeared normal. Surgical exploration confirmed the presence of the hydrocele and a 1.4-cm, pearly white, free-floating scrotal calculus, which was removed. The tunica vaginalis was excised, everted, and plicated to prevent future recurrence of the hydrocele. While rare, scrotal calculi should be considered when a free-floating lesion is detected in the scrotal sac, especially in association with a hydrocele. Surgery is the treatment of choice if patients are symptomatic and generally have a favorable prognosis. Further studies are needed to clarify the underlying causes of scrotal calculi and their prevalence, particularly in populations subject to repetitive scrotal trauma, such as athletes.

Appendicectomy, or the removal of the appendix, is an emergency procedure following symptomatic acute appendicitis. Diagnosis is made on clinical examination but can be confirmed on imaging if other abnormalities are suspected. A few variants of appendix anatomical position exist that can be difficult to manage. In addition, secondary findings during surgery can come unexpectedly. We report a case of a 14-year-old male, who presented to the emergency department at our government institution with abdominal pain and vomiting. Examination revealed an empty right scrotum, which was unnoticed by the patient and never examined previously due to residence in an area of limited healthcare access. Ultrasound done elsewhere was inconclusive. The surgical intervention showed a retrocecal appendix attached to an ascending colon terminating at hepatic flexure. The procedure was further complicated by the presence of the right intra-abdominal testis located below the cecum. Excised samples were sent for histopathology, and the patient was followed with biopsy reports. This case highlights the challenges encountered during routine appendicectomy with unusual findings.

Twisted testicular appendages had difficult differential diagnosis with testicular torsion. The objective of this paper is to evaluate the number, shape, size and determine the laterality pattern of the testicular and epididymal hydatids and evaluate the correlations between the length and width of the testicular and epididymal hydatids with testicular measurements. We analyzed 60 fixed cadavers and 16 patients with prostate cancer without previous hormonal treatment undergoing bilateral orchiectomy, totalizing 76 units and 152 testicles. In relation to the testicular appendices, we analyzed the following situations: absence of testicular and epididymis appendages, presence of a testicular appendix, presence of epididymis appendix, and presence of testicular and epididymis appendix. We measured the length, width and thickness of the testis and classified the appendages as sessile or pedicled. Chi-square test was used to verify associations between categorical variables. McNemar Test was used to verify differences between the percentages of right and left appendages. Correlations between quantitative measures were evaluated using the Pearson Correlation Coefficient (p < 0.05). In 50 cases (65.78%) we observed the presence of some type of appendices, in 34 cases (44.72%) we observed the presence of testicular appendices and in 19 cases (25%) the presence of epididymal appendices. We observed the presence of pedicled appendices in 39 cases (51.32%), with 25 of the cases (32.89%) of pedicled testicular appendices and 14 of the cases (18.42%) of pedicled epididymal appendages, with a significant association between the occurrence of appendices on the right and left sides (p < 0.001). Testicular hydatids were present in around two thirds of our sample being pedunculated in almost half of the cases with bilateral similarity. There is a significant chance in cases of twisted appendices that the same anatomical characteristics are present on the opposite side, which is a factor that tends to indicate the need for contralateral surgical exploration in cases of torsion, however studies with larger samples are needed to confirm these findings.

Tumors of the ovarian epithelial type of testis are an infrequent entity. We report a case of borderline serous tumor in an 18-year-old male who presented with a right testicular mass, clinically suspicious of carcinoma. After right inguinal exploration, two pedunculated para-testicular masses were identified in the appendix of the right testis and epididymis. The histological features were as complex papillary structures lined by columnar cells with mild to moderate pleomorphism. Microscopically, features of borderline serous testicular tumors are identical to the morphology of the same tumors encountered in the ovarian counterparts. These tumors usually reveal papillae with fibrovascular cores lined by stratified cuboidal to columnar epithelium. This case highlights a need for clinicians and pathologists to be aware of this infrequent entity and improve the best patient management attitude. Serous epithelial tumors are common ovary tumors but are very rare entities in the testis. These tumors originate from the remnant of Mullerian ducts or Mullerian metaplasia of tunica vaginalis and are nonaggressive, even associated with extra ovarian spread, and have outstanding prognosis. A review of the literature has shown nearly fifty reported cases worldwide, and most of the cases occur in young to middle-aged adults.