Acute abdomen caused by torsion of an undescended testis: A rare presentation and its diagnostic dilemma

Abstract

A B S T R A C TMost undescended testicles are asymptomatic and diagnosed in the first years of life. In some rare cases the diagnosis is established during childhood due to sudden torsion of the spermatic cord. Additionally, testicular torsion is a well-known urologic emergency that needs to be diagnosed and treated rapidly for the salvage of testis. We are here with reporting a case of torsion of an undescended testis with unusual clinical presentation, as acute abdomen, and its diagnostic dilemma and management.

Bell clapper deformity in female?

“…The gubernaculum ovarii, a fibrous band from the lower pole of the ovary ends close to the external inguinal ring on each side, and becomes the ovarian suspensory ligament cranially and the round ligament caudally, extending up to labia majora. A saccus vaginalis extending into the inguinal canal (canal of Nuck), normally gets obliterated, but however may remain patent after birth and provide a canal for potential indirect inguinal hernia [1] , [2] , [3] , [4] .…”

“…The inguinal canal in females normally transmits the round ligament of the uterus and the ilioinguinal nerve to the labia majora, a vein and an artery from the uterus that forms a cruciate anastomosis with the labial arteries. Incarceration of the bowel and female adnexa may occur especially in infants with inguinal hernia, due to a relatively short and oblique direction of inguinal canal and presence of a diverticulum or canal of Nuck, with the round ligament [1] , [2] , [3] , [4] .…”

“…In BCD, the tunica vaginalis covers the entire testicle and inserts high on the spermatic cord, allowing the testis to swing and rotate freely within the processus vaginalis, condition similar to the clapper inside a bell presenting as acute scrotum and acute abdomen in males. Similarly in females, if the ovarian vascular pedicle is narrow at the internal inguinal ring and the size of the ovary is relatively bigger, results inadequate fixation of the ovary and hence tending toward torsion easily [3] , [4] , [5] .…”

Acute Abdomen Revealing an Unusual Case of Intra-Abdominal Testicular Torsion

“…Intra-abdominal testicular torsion is a rare event [5,9,10]. Few cases have been described in the literature to date, and the true impact of this entity remains poorly understood [9][10][11]. Gerster was the rst author to report a similar case in 1898 [8,12,13].…”

“…e torsion of the testis in intra-abdominal position may be asymptomatic or may lead to nonspeci c signs including irritability, nausea, and vomiting, constipation, atypical abdominal pain, hematuria, or even shock, which can be misdiagnosed as appendicitis or diverticulitis [7,9,11,12]. Sometimes it can manifest as an abdominal mass [8].…”