TORSION IN A TRIORCHID TESTIS

Abstract

A healthy 15-year-old white boy presented with left lower abdominal discomfort and nausea 24 hours in duration. The pain started to localize to the left testis 12 hours later. Examination revealed a high riding and tender leR testis about twice the normal size of that of a fully virilized man. The right testis was normal. Exploration of the left hemiscrotum demonstrated 2 leR testes of similar size. The upper testis was clearly ischemic secondary to torsion of the blood supply, which was a division of the primary spermatic cord (fig. 1). This testis had a partially developed epididymis, and a normal appearing a p pendix epididymis and blood supply. There was no evidence of a vas deferens or gubernacular attachments. The lower testis appeared normal with a fully developed epididymis, vas deferens and blood supply but with no appendix epididymis. The position was anatomically normal with intact gubemacular attachments. Simple orchiectomy of the ischemic testis was performed. Histological examination of the removed testis demonstrated elements of spermatogenesis amid extensive ischemic changes and necrosis (fig. 2).