Polyorchidism with presumed contralateral intrauterine testicular torsion

Abstract

Introduction: Polyorchidism was first described by Blasius in 1670(1) during a routine autopsy. We report a child with unilateral polyorchidism and a contralateral absent testis, a combination not reported previously.

Presentation of case: A 2-year-old boy was referred to the outpatient clinic with an impalpable left testis. At laparoscopy, the left vas deferens and testicular vessels ended blindly proximal to a closed internal ring. No gonadal tissue was identified. On the right side, a single vas deferens and testicular vessels were seen entering the internal ring as normal. The right side of the scrotum was explored and two testes were identified within a single tunica vaginalis.

Discussion: Polyorchidism is rare with a literature search identifying approximately 230 reported cases. Whilst prenatal testicular torsion is increasing being recognized and treated as a surgical emergency,(9) prenatal testicular torsion in association with polyorchidism has not been previously reported.

Conclusion: We describe a unique case of a 2-year-old boy with right-sided polyorchidism and an absent left testis associated with a blind ending vas deferens and testicular vessels, presumed secondary to intrauterine testicular torsion.

Keywords: Intrauterine testicular torsion; Polyorchidism.

Fig. 1

Laparoscopic view of the left internal ring showing a blind ending vas deferens and testicular vessels and a closed internal inguinal ring (arrow).

Fig. 2

Laparoscopic view of the right internal ring showing a normal vas deferens and blood vessels entering a patent internal inguinal ring (arrow).

Fig. 3

Operative appearance at scrotal exploration. The lower larger testis (large arrow) was connected to a vas deferens and testicular vessels while the smaller superior testis (small arrow) had its own testicular vessels but no vas deferens.