Cryptorchid testicular tumour presenting with torsion

ABSTRACT

An undescended, cryptorchid testis is predisposed to 3 to 40 times risk of malignancy. Torsion of a cryptorchid testis is more difficult to diagnose than a normally placed testis. We present a case of a 25-year-old man with acute abdomen due to the torsion of an intra-abdominal testis. Case Reports A 25-year-old male reported in the Emergency Department of the Liaquat University Hospital [LUH], Hyderabad, with a history of lower abdominal pain for 3 days not responding to parenteral analgesics and vomiting. There was history of several similar past attacks resolving spontaneously. On examination, the patient was anxious, pyrexial and dehydrated with a pulse rate of 110/min. The abdomen was very tender, more so in the umbilical and sub-umbilical region. The right scrotum was empty. Digital rectal examination [DRE] revealed mild tenderness anteriorly. His leukocyte count was raised [20 x 109 /l]. Plain abdominal x-ray showed a few air-filled bowel loops in the lower abdomen. Ultrasound examination showed a well defined, mixed echogenecity mass in the pelvis. Laparotomy was performed on the same day through a right paramedian incision. A swollen and congested testis, not gangrenous, approximately 15 x 10 cms in size, was identified deep in the pelvis, which had partially twisted on its pedicle. The testis was delivered and orchidectomy was done. Postoperative recovery was uneventful. Histology revealed seminoma with marked necrosis in the removed testis. The patient was subsequently investigated to stage the tumour whence no evidence of metastases was found. The patient was referred to the Atomic Energy Medical Centre [AEMC], Jamshoro, for radiotherapy. A follow-up of nine months showed no evidence of recurrence or metastases