outward toward the thigh (and may require more than one rotation ( Fig 61.5 ) Relief of pain and a lower position of the testis in the scrotum suggest a successful outcome Even if only partially successful, decreasing testicular rotation may allow some reperfusion, act as a bridge to definitive surgical management, and lead to lower orchiectomy rates Orchiopexy of both the affected testis and the contralateral one, which is malfixed in more than 50% of cases, is still recommended Torsion of Testicular Appendage Several vestigial embryologic remnants are attached to the testis or epididymis that may twist around their base, producing venous engorgement, and subsequent infarction Appendage torsion is most common in boys of ages to 12 years but can occur at any age Mild to severe scrotal pain is the usual presenting feature There can be associated nausea or vomiting, although less commonly than in testicular torsion (see Chapter 119 Genitourinary Emergencies )