Is Being Overweight a Risk Factor for Torsion of the Appendix Testis in Children?: A Paired Case-Control Study

Abstract

Objective: This study aimed to determine whether being overweight during childhood is a risk factor for torsion of the appendix testis (TAT).

Methods: We conducted a paired case-control study with all boys surgically treated for TAT, paired by age and sex with patients who were seen in the emergency department for a reason other than acute scrotum. Age and weight were registered, and weight percentile (WP) by age was calculated and compared between groups. Weight percentile was classified into 4 groups (<25, 25-50, 50-75, >75), and a conditional logistic regression analysis was performed to establish the risk of TAT related to the WP.

Results: A total of 980 patients were diagnosed as having TAT in our institution, of which 118 patients (12%) were surgically treated and randomly paired with 118 controls. Mean age was the same in both groups (11.2 years, P = 0.908). Patients with TAT had a higher median of WP (79; interquartile range, 49-94) than the control group (49; interquartile range, 20-79; P < 0.0001). For each WP point increase, risk of TAT raised by 2.2% (odds ratio [OR], 1.022; 95% confidence interval [CI], 1.011-1.032; P < 0.001). Weight percentile >75 increased the risk of TAT: 6-fold compared with WP <25 (OR, 5.9; 95% CI, 2.5-14; P < 0.001), 4-fold compared with WP of 25 to 50 (OR, 4.3; 95% CI, 1.8-10.5; P = 0.001), and 3-fold compared with WP of 50 to 75 (OR, 3.3; 95% CI, 1.5-7.6; P = 0.004).

Conclusions: Overweight increases the risk of being operated on because of TAT. Because obesity is a rising problem, a greater incidence of TAT remains to be proved.