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

Abstract

Introduction. Intra-abdominal testicular torsion is a rare event. We report hereby our experience of the management of a spermatic cord twist on intra-abdominal testis discovered during an acute surgical abdomen. Case Presentation. This was a 42-year-old patient admitted to the emergency department for abdominal pain that had been evolving for a week. The physical examination showed tenderness and guarding in the left iliac fossa with an empty ipsilateral hemiscrotum. Complementary examinations led to the discovery of an intra-abdominal left-lateral mass. The laparotomy found a whitish mass with areas of infarction, which was resected. Anatomopathological examination of the operative specimen identified it as a testis with atrophy of germ cells and necrotic areas without evidence of malignancy. Conclusion. Intra-abdominal testicular torsion should be considered in case of patients with an acute surgical abdomen with vacuity of one of the bursae.

Intra-abdominal undescended testis associated with seminoma manifesting as acute appendicitis; An extremely rare clinical presentation; Case report

“…If physician could not palpate the testicle intra-abdominal UDT is suspected. However, evidence showed that either non-palpable or intra-abdominal testicle was present among 50-60% of cases [3]. Transverse testicular ectopia is also a rare condition in which both of testicles locate in ipsilateral scrotal sac and in contralateral side there is either empty scrotum or non-palpable testicle [6].…”

“…Cryptorchidism is most commonly seen among premature male infants and usually resolves spontaneously by descending through the empty scrotum during the first year of the life. Testicular atrophy, infertility, exposure to traumatic events, and malignant degeneration proceed in association with permanent testicular tissue degeneration after 3 years of age if no treatment schedule for the UDT [1][2][3]. UDT is usually isolated, although it is also seen in some multisystem syndromes including Prader-Willi and Eagle-Barret.…”

“…Patient with intra-abdominal untreated UDT is also susceptible for testicular torsion followed by mass enlargement which is accompanied by acute sever pain, nausea, vomiting, constipation, hematuria, atypical abdominal pain and even shock [9,10]. While these signs present it is more familiar with mind to suspect acute appendicitis or diverticulitis in compare with intra-abdominal tortuous UDT [3]. On the contrary, acute appendicitis could present itself with whether unilateral or bilateral scrotal pain, inflammation, mass, abscess formation, and epididymitis [2,8,[11][12][13][14].…”

“…Untreated UDT particularly intra-abdominal type is susceptible for malignant degeneration because of exposure to higher core body temperature [1]. Namely over 50% of testicular tumors occurred in testes failed to descend [3]. Germ cell tumors (GCT) involve 95% of all testicular malignancies in which over 50% are diagnosed as seminoma [1].…”