Empty Scrotum Research Articles

Perineal discomfort caused by the sitting position as a rare manifestation of ectopic testicle: About two cases

Background and importancePerineal ectopic testis (PET) is a rare congenital anomaly; the diagnosis is typically made by conducting a physical examination of the ectopic areas and noting an empty scrotum on the corresponding side. We report two pediatric cases of PET in whom this condition was diagnosed by a discomfort induced by the sitting position. Cases presentationTwo cases of PET were operated on in our pediatric surgery department over the past three years. Patients were referred for perineal discomfort in the sitting position. Children had difficulty staying seated at home or school, this was described by parents as an abnormal fussiness after sitting. The age at diagnosis was five and three years. The diagnosis of perineal testicular ectopia was made through physical examination. Orchidopexies to the corresponding scrotum were performed in both cases via an inguinal approach. No postoperative complication was noted with a follow-up of 24 months. Clinical discussionPET is typically diagnosed through clinical examination, characterized by an empty scrotum and a palpable perineal mass. The exact aetiology is unclear, but it involves abnormalities in testicular descent mechanisms, particularly the gubernaculum. PET can cause perineal discomfort when sitting, a symptom observed in the two pediatric cases presented. Early surgical intervention via orchidopexy is crucial to prevent complications. Both reported cases were successfully treated with no postoperative complications and resolution of discomfort. Prompt diagnosis and treatment are essential for preserving testicular function. ConclusionPerineal discomfort on sitting was the defining diagnostic element in our cases. In practice, this symptom should be a prompt for a thorough perineal examination in children with an empty scrotum. However, the patient's age and ability to express himself determine the significance of the symptom.

A spontaneous acute abdomen revealing testicular torsion of an undescended testicle

Torsion of an ectopic testicle is an exceptional condition, occurring mainly in young adults. Its etiopathogenesis is still poorly understood. The clinical picture consists of the sudden onset of abdominal pain without fever, associated with a palpable inguinal mass and an empty scrotum. Medical imaging appears to play a limited role. The management of torsion of an undescended testicle involves urgent surgical exploration. An inguinal incision allows diagnosis, detorsion, reduction and orchidopexy in dartos after lowering the testicle if the testicle is viable and the spermatic cord is of sufficient length.

Neonatal X-linked myotubular myopathy with a de novo mutation: A case report and literature review.

X-linked myotubular myopathy (XLMTM) is a rare congenital myopathy. In February 2021, a male neonate was admitted to the West China Second University Hospital, Sichuan University, with clinical manifestations of hypotonia, accompanied by distinctive facial features, and requiring continuous ventilatory support. He was born prematurely at 36+2 weeks gestation and developed respiratory distress postnatally, followed by difficulty in weaning from mechanical ventilation. Additional clinical features included hypotonia of the limbs, swallowing dysfunction, and specific facial characteristics (elongated limbs, narrow face, high-arched palate, wrist drop, empty scrotum, elongated fingers/toes). Genetic testing confirmed the diagnosis of XLMTM. Whole-exome sequencing analysis of the family revealed no mutations in the father, paternal grandfather, or paternal grandmother, while the mother had a heterozygous mutation. The pathogenic mutation was identified as MTM1 gene (OMIM: 300415), chromosome position chrX-150649714, with a nucleotide change of c.868-2A>C. The patient exhibited typical facial features. Genetic testing is crucial for accurate diagnosis of XLMTM in infants presenting with abnormal muscle tone and distinctive facial features.

Ectopic Testis, Pubo-Penile: A Rare Entity

Background: Pubo-penile ectopic testis is a rare congenital anomaly in which the testis is situated along the penile shaft or along its root. We are reporting a rare case of penile testicular ectopia whose etiopathogenesis is poorly understood. We describe one case of Pubo-penile ectopic testis in a Eleven-years-old child. The diagnosis was made on physical examination alone. The condition was present since birth but child presented late and successfully treated.
 Clinical Description: 9 yrs old male child presented with swelling along base of penis since birth. On examination, left hemi-scrotum was empty with poorly developed scrotal sac. External genitalia was normal and appropriately developed. There was a single, firm, well defined, non-tender, mobile, oval shaped swelling of size 3.5 X 2.5cms, palpable at the base of the penis. Right sided testis was normally placed in scrotum. Testicular sensations were intact.
 Management: Ultrasound abdomen and inguino-scrotal region was done & it confirmed the ectopic location of the testis. Incision was given over the swelling at the base of penis to mobilise the testis along with spermatic cord and it was taken through the superficial ring in to the scrotum by small inguinal incision. Orchidopexy was done & testis was anchored in the left extra dartos pouch. Postoperative period was uneventful and child was doing good in follow-up.
 Conclusion: Pubo-penile ectopic testis is rare. Examination of a child with an empty scrotum should include examination of all potential ectopic sites. The diagnosis is based on physical examination. Treatment is surgical and long-term prognosis is excellent.

Abstract #1407524: Endocrinopathies in Rubinstein Taybi Syndrome (RTS)

Rubinstein-Taybi syndrome (RTS) is a rare genetic disorder with a constellation of physical characteristic features, including a high-arched palate, broad thumbs, and microcephaly. It is associated with many endocrinopathies that need to be identified and treated. We present a case of RTS with associated hypogonadism, obesity, and type 2 diabetes Mellitus (DM). The patient is a 47 y/o man with a history of Rubinstein-Taybi syndrome, diagnosed at 3, presented to our clinic at age 33 for continued management of hypogonadism. He had been treated with IM testosterone injection but was not compliant. His past medical history was significant for a seizure disorder, recurrent respiratory infection, and undescended testes for which he had surgery at age 5 and 11. Family history was positive for type 2 DM. He denied smoking and illicit drug use; however, he reported occasional alcohol use. Upon initial evaluation, VS: BP 109/63, HR 71, Ht 67.1 inches, Wt 265 lbs with a BMI 41.5. A physical exam showed an obese man with facial dysmorphism of microcephaly, up-slanted palpebral fissure, overcrowded teeth, broad bilateral thumbs, fifth fingers, and first toes. A wide space between the 1st and 2nd toe was noted, with sparse pubic and axillary hair, a small testis on the right, and an empty scrotum on the left. Labs were pertinent for total testosterone 134 ng/dl (264-916 ng/dl), FSH < 0.3 mIU/ml (1.6-8.0 mIU/mL), LH < 0.1 mIU/ml (1.5-9.3 mIU/mL), and WBCs 17.3 x10E3/uL. Initial HbA1c 6.3%. Scrotal US revealed an empty left scrotum and hypovascular small right testis. Persistent leukocytosis was noted, ranging between 17.3-12.4 x10E3/uL, for which he was sent to hematology; subsequent evaluation was unremarkable. Over the years, he progressed to type 2 DM, for which he is receiving glucagon-like peptide-1 receptor agonist (GLP-1) and metformin. With the addition of the GLP-1, his BMI decreased from 41 to 31, and his most recent HbA1c was 6.2%. For hypogonadism, he continues on IM testosterone injections. RTS is a rare congenital condition linked to abnormalities in the CREBBP or EP300 genes as a result of microdeletion of chromosomes 16. 90% of cases survive to adulthood. Common endocrine conditions associated with RTS are congenital hypothyroidism, thyroid hypoplasia, growth hormone deficiency, and pituitary hypoplasia. Obesity is common, especially in adulthood; however, DM was not reported in the literature. Cryptorchidism is noted in over 70% of the cases. Of note, leukemia and lymphoma have also been linked to this syndrome; however, our patient's workup so far has been negative. The medical care for RTS patients is not standardized due to its incredibly rare nature. Our case is unique as there are no reported RTS patients with diabetes. These patients are at increased risk of obesity which will increase the risk of type 2 DM.

Persistent Müllerian Ducts Syndrome: A Case Report

We report the case of a 6 years old child, admitted for management of testicular ectopia, the clinical examination found an empty scrotum, a normal looking penis and a urethral meatus in place. The scrotal ultrasound showed an intra-abdominal testicle (left illiac fossa) of homogeneous echostructure on the left side, while the right testicle was not visualized. The gonadotropins LH and FSH levels were low, as well as the level of testosterone, the secretion of which is stimulated after administration of Pregnyl. Laparoscopy revealed 2 gonadal formations on the same side, 2 tubes and a median formation reminiscent of the uterus. The karyotype of the patient was male 46XY, the dosage of anti Müllerian hormone (AMH) was high, confirming an abnormality of its receptors, which explains the persistence of the Müllerian ducts in this child. The child underwent a left gonadectomy with bilateral hysterectomy and adnexectomy, associated with a lowering of the right testicle. At 9 years, pubertal development was classified as T3P4 according to Tanner's classification, scrotal ultrasound showed a free left testicular compartment with testicular calcifications classified as grade 3, and tumor marker levels were normal.

Undescended Testis Revealing Triorchidism in a Child: A Case Report

Polyorchidism is a rare genitourinary congenital malformation, which diagnosis is generally fortuitous in children. We report the case of a 7-year-old boy admitted to the pediatric surgery service of Donka University Hospital in Conakry for an empty left scrotum. Initially, the diagnosis of left cryptorchidism had prompted orchidopexy by inguinal approach, whose intraoperative exploration revealed two undescended left testicles. The first, located at the deep ring of the inguinal canal, had normal volume, while the second, located in the inguinal canal, was hypotrophic. The orchiectomy of the latter was performed, associated with a dartos-pouch orchidopexy of the testicle of normal volume. After one year of follow-up, no complications were noted.

426 Conservative Management of Bilateral Undescended Testes in an Adult

Abstract Bilateral undescended testes are an uncommon finding in children and even a rarer phenomenon in adults. Undescent of the testes (UDT) has important consequences on fertility, testicular injury, hormonal concerns, testicular torsion, and testicular cancer risk, as well as psychological health. We present the case of a then 21-year-old native caucasian who was referred to the urology clinic with an ‘empty scrotum’ in 2009. On examination, he had secondary sexual characteristics with expected pubertal transformation. Testes were palpated as small smooth ovoid masses in each groin with the inability to be reduced into the scrotum. The basic hormonal screen was within the normal range. Ultrasound of the scrotum and groins identified testes in the left and right inguinal canal, respectively. Semen analysis showed azoospermia. Treatment wise no pharmacological therapies were warranted in view of normal hormonal function. The patient opted for conservative options for fertility in view of likely low success rates in atrophic testes including sperm extraction techniques After detailed discussions around the dilemmas of Bilateral UDT, a decision for a tailored surveillance regimen including ultrasound and self-examination was taken. Psychological counselling was declined by the patient as felt unwarranted. He continues to remain well in himself to date with his wife and adopted children. Greater awareness of testicular self-examination amongst young men should be advocated. With established neonatal screening availability, UDT in adults is seldom heard of but it is a primary risk factor for testicular cancer. Proper counselling advice and prosthesis should be offered proactively.

A RARE CASE OF PERINEAL ECTOPIC TESTIS

In Perineal ectopic testis (PET), the testis is located between the penoscrotal raphe and genitofemoral fold. PET incidence is &lt; 1% of all undescended testis. It is a rare congenital anomaly. This article reports a case of an inguinal orchidopexy of the ectopic testis on a male patient aged 9 year presenting a right testicle located in right perineum. Examination of patient with empty scrotum (maldescent testes) should include examination of sites like perineum to look for ectopic testis.

Clinical and diagnostic characteristics of complex III mitopathy due to novel BCS1L gene mutation in a Saudi patient

BackgroundOf the many types of mitochondrial diseases, mutations affecting BCS1L gene are regarded as chief cause of the defective mitochondrial complex-III, affecting normal mitochondrial functioning, and leading to wide variety of phenotypes.Case presentationIn this case report we describe a novel genotype linked to a unique phenotype in a Saudi patient born of a consanguineous marriage. Detailed genetic analysis and whole genome sequencing identified a novel homozygous missense mutation in exon 5 c.712A > G (p.Ser328Gly) of the BCS1L gene, with predicted deleterious effects on the functioning AAA+-ATPase domain of the protein characterized by distinct clinical presentation associated with profound multisystem involvement, conductive hearing loss, absent external auditory canal, low posterior hair line, short neck, micro and retrognathia, over riding fingers, rocker bottom foot, small phallus with bilateral absent testis (empty scrotum) and intolerable lactic acidosis.ConclusionsA pathogenic effect of this novel BCS1L mutation was reflected in the patient with his failure to thrive and a complex clinical and metabolic phenotype.

Abstract 82: Rare case of 46XY OVO testicular DSD

A 5-month-old term baby was referred for ambiguous genitalia. Examination showed a right descended gonad, and an empty scrotum and an inguinal swelling on the left, no phallus and single external urogenital opening in the perinium with an EMS score of 2.5. Possibilities considered included ovo-testicular DSD, PAIS and testosterone biosynthetic defects. Beta HCG Stimulation test ruled out synthetic defects and with good testosterone response. USG abdomen/scrotum showed left inguinal undescended testes. Post Acton prolongatum stimulated cortisol was 43 mcg/dL and the Karyotyping was 46 XY. Diagnostic laparoscopy showed a left sided ovotestes with fallopian tube-like structure attached; and biopsy of gonad confirmed both ovarian and testicular tissue. Hence diagnosis of 46 XY Ovo testicular DSD was made; one which accounts for 3-10% of total DSD. We report this instance where absence of phallic structure is a rare presentation among cases of 46XY Ovo testicular DSD.

English

Cryptorchidism is a common congenital malformation of the male genitourinary tract. The malignant potential of cryptorchidism in undescended testes is ten percent with the risk being highest in intra-abdominally located testes. In our case report, a 25-year-old man presented with a lower abdominal mass, which was nontender and of two months duration. Physical examination of the scrotum revealed an empty left scrotum and inguinal canal. Computed tomography scan, exploratory laparotomy and histopathological examination revealed an intrabdominal testicular seminoma (germ cell tumour). The purpose of our case report is to highlight the need for routine scrotal examination in addition to routine physical examination in all men who present with an abdominal mass to rule out the possibility of an intraabdominal testicular neoplasm. Cryptorchidism is defined as the absence of one or both testes from the scrotal sac and is one of the most frequently encountered birth defects of the male genitalia.1 The prevalence amongst full-term neonates is three percent and 30 % in preterm neonates.2 There is a higher potential for malignant transformation for cryptorchid testes than normally descended testes. They also predispose to ischemia and infertility later in adulthood.3 Seminoma (germ cell tumour) is the most common malignant transformation of an undescended testis.4 A 25-year-old male complaining of a painless, slow-growing abdominal mass found to have intraabdominal testicular seminoma in an undescended testis and confirmed histopathologically, is presented in this case report. We wanted to highlight the importance of considering testicular germ cell tumours in the abdomen and the importance of performing a groin examination in a patient presenting with an abdominal lump with an empty scrotal sac.

Clinicopathological Spectrum of Testicular and Paratesticular Lesions

Background: Both neoplastic and non neoplastic conditions affect the testis. Although non neoplastic testicular lesions are more common, still most of the published studies are done on testicular neoplasms only. Hence the present study was undertaken to study histopathological spectrum of testicular and paratesticular lesions, their age distribution and clinical presentation. Materials and Methods: This is a retrospective study of 77 cases of orchidectomy specimens, testicular biopsies and paratesticular lesions received in the department of Pathology. Results: Non neoplastic testicular lesions were more common than neoplastic (90.1% Vs 9.8%) with majority in the second and third decade. Undescended testis comprised 46.1% of the total orchidectomy specimens followed by Torsion/Infarction testis (15.3%). None of the undescended testis showed tumour deposits unlike western countries. Majority of patients presented with empty scrotum (31.16%) and testicular/scrotal swelling (18.11%). Only 5 cases of testicular neoplasm were diagnosed during the study period amounting to only 1.42 cases per year. All were germ cell tumours (4 classic seminoma and 1 yolk sac tumour). Conclusions: Non neoplastic testicular lesions were more common than neoplastic lesions. Complete neonatal examination for testicular descent should be mandatory to avoid late presentations and future malignancies. Germ cell tumours formed the bulk of testicular tumours.

The role of laparoscopy in non-palpable undescended testicle: Analysis and review of the experience from two cities in Sudan.

Introduction:It is estimated that 1%–2% of male infants have undescended testicles. The reliability of ultrasound (US) to identify the non-palpable undescended testicles (NPUDT) is controversial. Laparoscopy remains the gold standard to diagnose and manage NPUDT.Objective:The objective is to highlight the role of laparoscopy in the management of NPUDT in 2 cities from Sudan over the past decade.Materials and Methods:Patients presented to Gadarif Teaching Hospital and Almak Nimir University Hospital with NPUDT were assessed by clinical examination and US. The testis, when found during laparoscopy, was either brought down to the scrotum in a single or two-stage or removed depending on the findings. Data were collected and analysed.Results:Patients covered the age range between 18 months and 65 years. The average was 12.4. The majority, 94 (67.2%) patients were older than 5 years. The main presenting symptom was either bilateral or unilateral empty scrotum. In 12 (8.4%) patients, the main presenting symptom was primary infertility. US was done in 120 (86.6%) of the patients and failed to see the testis in more than half of them. A single-stage procedure in the form of laparoscopic search assisted with orchidopexy was achieved in 90 (62.9%) patients and orchiectomy in 13 (9.1%) patients, while in 12 (8.4%) patients the testis was not found. Other procedures were applied on the 28 (19.6%) patients who needed staged operation in the form of Fowler Stephen's, in bilateral cases, in 6 (4.2%) patients. Shehata's operation in nine patients (64%) and open orchidopexy for 8 (5.6%) patients. The post-operative complication was encountered in 14 (9.8%) of the patients in this group in the form of bleeding, vassal injury and testicular atrophy.Conclusion:Laparoscopy provides the most accurate interventional option for managing patients with NPUDT. Laparoscopic orchidopexy, whether single stage for low or 2-stages for high intra-abdominal testis, is a proven and effective extension of lap-search with minimal complications.

Testicular Torsion in Cerebropalsy Patient with Undescended Testis: Do Not Misdiagnose it!

We report a 13-year-old male patient with cerebropalsy, presented with right inguinal swelling since 12 hours. Physical examination found a firm painful swelling in the right inguinal region and an empty controlateral scrotum. Exploration found a testicular torsion with undescended testis. Detorsion and Orchidopexy were performed. Follow up was uneventful

Cosmetic Appeal, HRQoL, and Effectiveness of Simple and Pseudotesticular Techniques of Orchidectomy in Prostate Cancer.

Introduction Orchidectomy is the most cost-effective means of hormonal therapy for locally advanced or metastatic prostate cancer (LAMP). However, cost-effectiveness should not detract from health-related quality of life (HRQoL) considerations. Bilateral simple orchidectomy (BSO) has been linked to negative psychometric deficits from an empty scrotum. This study compared the HRQoL, therapeutic efficacy, and cosmetic appeal of BSO with endogenous pseudotesticular techniques of bilateral subcapsular orchidectomy (BSCO) and bilateral-epididymal-sparing orchidectomy (BESO). Research Design. Nigerian patients with LAMP were randomised into three surgical arms: BSO, BSCO, and BESO. Expanded Prostate Cancer Index Composite-26 HRQoL and sociodemographic questionnaires were administered before and three months after orchidectomy. Serum testosterone and PSA were measured at 0, 1, 2, and 3 hours; 7 days; and 3 months postoperatively. Pseudotesticular volumes and cosmetic appeal were assessed at 3 months. Result Sixty-three patients were recruited (24 BSO, 21 BSCO, 18 BESO), 73% of whom were low-income earners. There was no significant difference in the procedure cost nor the PSA or testosterone nadirs achieved over the three-month follow-up period (11.3, 12.6, 15.2 ng/ml (p=0.667) and 0.44, 0.64, 0.79 nmol/l (p=0.603) respectively). Those with pseudotesticles (BSCO, BESO) felt less emasculated (p=0.010). BSCO produced the least sexual bother, highest sexual function, and largest pseudotesticular volumes. The cosmetic appeal scores were similar between groups (77.9 ± 22.8, 81 ± 13.9, and 81.9 ± 22.5, respectively, p=0.858). Conclusion Endogenous pseudotesticular techniques, when compared with BSO, reduce the negative psychological impact experienced by patients without increasing costs. BSCO produced the best pseudotesticular volumes and postoperative sexual function. This study is registered with the ClinicalTrials.gov of the National Institute of Health U.S. National Library of Medicine as TEPSO study, NCT03744494: Comparison of the Therapeutic Efficacy and Patient Satisfaction of Three Techniques of Bilateral Orchidectomy in Prostate Cancer Patients of a Nigerian Sub-population. Registration completed on 16th of November, 2018 (registered retrospectively) NCT03744494.

Safety and Efficacy of Laparoscopic Management of Intracanalicular Testes in Pediatrics.

Introduction: Undescended testis is a relatively common congenital anomaly in male children with a prevalence of 1%-2% in live births. Upon discovering an empty scrotum, it is important to determine whether the testis is palpable, ectopic, retractile, or nonpalpable. A canalicular or "emergent" testis is a peeping one that freely slides to and fro between the abdominal cavity and inguinal canal. It may be impalpable initially, but at a time, it emerges from the internal ring to be palpable when it is "milked" down (where it was concealed from detection). It is reported that 15%-40% of cryptorchidism are viable peeping/canalicular testis. The laparoscopic approach for treating intracanalicular undescended testes offers many advantages over open inguinal orchiopexy. It maintains the integrity of the inguinal canal and eliminates the need to divide the epigastric vessels during dissection. The ability to dissect the testicular vessels at a higher level would increase the vessel length available to bring the testis down to the scrotum without strain. The aim of this study is to present our experience and evaluate laparoscopic approach for management of intracanalicular testes regarding operative safety, efficacy, and postoperative outcomes. Patients and Methods: This is a prospective study conducted at Department of Pediatric Surgery, MCH Hospital, Bisha, Saudi Arabia and Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt, in the period from October 2018 to August 2020 to evaluate the safety and efficacy of laparoscopic orchiopexy for intracanalicular testis. Patients with retractile testes, ectopic testes, testes located distal to the external inguinal ring, and nonpalpable testes were excluded from the study. Results: The study was conducted on 62 male children with 70 intracanalicular (peeping) testes, with age range from 8 months to 48 months (mean age: 24 months). Among them, 26 cases (∼42%) were left-sided, 28 (∼45%) were right-sided, and 8 (∼13%) cases were affected bilaterally. Postoperatively, all testes maintained good size without postoperative hydrocele or inguinal hernia. One case (1.4%) required open redo-orchiopexy because of testicular re-ascent to the level of scrotal neck. Moreover, there was no evidence of testicular atrophy confirmed by postoperative ultrasonography. All patients had good satisfied cosmetic results obtained by parent's questionnaire at postoperative follow-up visits. Conclusion: Laparoscopic orchiopexy for management of (intracanalicular) undescended testes is safe, effective, less invasive, without disturbance of inguinal canal anatomy, and with better cosmetic results.

SEMINOMA ARISING FROM TESTICULAR AND OVARIAN REMNANTS HERALDS THE EMERGENCE OF A RARE MALE OVOTESTICULAR DISORDER OF SEXUAL DEVELOPMENT

INTRODUCTIONOvotesticular Disorder of Sex Development (OT DSD) or true hermaphroditism is a very rare subset of DSD and accounts for only 5% of cases. It has great phenotypic variability and poses diagnostic challenge to clinicians. It usually presents in childhood with ambiguous genitalia, characterized by histologic demonstration of ovarian and testicular tissues within the same individual. RESULTSWe describe a 22-year-old man with OT DSD complicated by seminoma. He was delivered preterm with ambiguous genitalia and was lost to follow-up. He was raised as a female, at 14 years old, his teachers referred him due to concerns of male phenotype while participating in competitive sports. Phenotypically, he was a developed male with a micropenis, hypospadia, left scrotal cystic structure and empty right scrotum. Chromosomal analysis revealed 46XY and presence of SRY gene. Radiological imaging at age 16 showed fully developed Mullerian structures, with a single cervix and incomplete septate uterus, and an oval structure suggestive of testes at the left hemipelvis. Cysto-genitoscopy demonstrated normal urethra without prostatic urethra, opening at posterodistal bladder neck with blood clots likely representing the vagina. Laparoscopy identified tubulo-nodular structure inside the pelvis suggestive of vas deferens with suspicious early malignant changes. Wolffian remnant and bicornuate uterus were present with a right Fallopian tube with suspicious hydro-corpus. He was advised surgery, however, he defaulted again. He consulted again at age 22 due to pyuria, suprapubic pain and painless cyclical haematuria. Imaging studies demonstrated pyometra, bulky left ovary and bilateral undescended testes suspicious of malignant transformation. Exploratory laparotomy, gonadectomy, subtotal hysterectomy and left orchidectomy were performed. Histopathological examination revealed seminomas arising from testicular and ovarian remnants with suppurative inflammation in the uterus. He was provided testosterone replacement post operatively, and received chemotherapy (etoposide, bleomycin and platinum). CONCLUSIONThe complexity of the case exemplified the pivotal role of multidisciplinary input from various specialties.

Rare case of simultaneous bilateral testicular torsion in inguinal canal: A case report

Background: Simultaneous bilateral testicular torsion in inguinal canal is a very rare condition which mandates prompt surgical intervention. Case Report: We report a case of an adolescent male presenting with complaint of severe pain in left inguinal region. Diagnosis of bilateral testicular torsion with bilateral undescended testes was made clinically and supported by Doppler study. This was followed by emergent surgical exploration requiring left orchiectomy and right orchiopexy. Conclusion: A high index of suspicion is required in any patient presenting with lower abdominal or groin pain and an empty scrotum to clinch the diagnosis and act promptly in an effort to salvage the testes. We believe, irrespective of the time elapsed since the onset of symptoms, surgical intervention should be undertaken as spontaneous torsion and detorsion might be happening, enabling testicular salvage.

Ruptured intra-abdominal testicular seminoma with hemorrhage shock, after inadequate surgical exploration for undescended testis: a case report

BackgroundUndescended testes are associated with an increased risk of malignancy and infertility, and surgical treatment in childhood is recommended.Case presentationA 35-year-old man presented to the emergency department with abdominal pain and vomiting. Despite a history of surgery for a left undescended testis in infancy, his left-sided scrotum appeared underdeveloped. Contrast-enhanced computed tomography showed a pelvic mass, involving a major axis of approximately 15 cm, with high-density ascites suggestive of hemorrhage. A ruptured gastrointestinal stromal tumor was suspected. As he was in hemorrhagic shock, an emergency laparotomy was indicated. The active bleeding mass was controlled through complete resection. A pathological evaluation of the mass revealed a seminoma arising from an undescended testis. His post-operative course was uneventful, and he was discharged on post-operative day 6. Recurrence on the retroperitoneal lymph nodes was detected 1 year postoperatively, and a retroperitoneal lymph node dissection was performed after chemotherapy. He remains well without any apparent signs of recurrence.ConclusionsPaying close attention to an empty scrotum is advisable, even postoperatively, for undescended testis because of possible subsequent potential malignancy presenting with hemorrhage, as our patient demonstrated.