Ultrasonography Crucial in Preoperative Diagnosis and Rescue of Ectopic Testis with Torsion: Case Report

Diagnosing a twisted ectopic testis, a rare condition, presents a significant challenge, particularly when the testis is not located in the scrotum. Failure to diagnose this condition preoperatively can lead to testicular necrosis. The clinical case reported by Takayuki Fujii, Department of Pediatric Surgery, Kagawa University, Takamatsu, Japan, and colleagues highlights the successful use of ultrasonography in diagnosing and rescuing a twisted ectopic testis before surgery.

The case concerns a patient, a generally healthy 13-year-old boy, who was referred to the Urology Department after experiencing a painless swelling in the left inguinal region for two weeks, followed by mild exercise-induced pain in the same area one week before his referral. The condition did not worsen despite the persistent mild pain.

Upon examination, a mildly tender swelling was observed in the left inguinal region, and the left half of the scrotum was empty. The right testis was found to be normal in size and position. Ultrasonography was employed to further investigate the issue. The imaging revealed that the left spermatic cord was present within the inguinal canal and exhibited spiral twisting. The left testis was positioned above the inguinal canal and appeared normal in echogenicity but was notably smaller than the right testis (right testis: 41 × 28 × 16 mm; left testis: 18 × 18 × 8 mm). Power Doppler ultrasound showed normal blood flow to the left testis.

The findings led to the diagnosis of an ectopic testis with torsion. During surgery, the intraoperative examination confirmed that the testis was indeed located in the left superficial inguinal pouch. Although the testis had twisted five and a half turns (1980°) clockwise, no signs of ischemia were evident. Orchidopexy was performed on both testes, and the size of the left testis was preserved post-surgery.

This case underscores the importance of considering an ectopic testis in the differential diagnosis when an inguinal swelling is present, and no testis is palpable in the scrotum. While diagnosing a twisted ectopic testis preoperatively can be challenging, ultrasonography proved to be a valuable tool in this case, enabling accurate diagnosis and effective management by tracking the spermatic cord and confirming the testicular torsion.

"When an inguinal swelling is observed, and the testis has not descended into the scrotum, an ectopic testis should be considered in the differential diagnosis. Ultrasonography is essential for distinguishing between an inguinal swelling and an inguinal hernia. Furthermore, careful monitoring of the spermatic cord's course can help in ectopic testis diagnosis," the researchers concluded.

Reference:

Fujii T, Satoh H, Sato A, et al. (August 02, 2024) Utility of Ultrasonography for Diagnosing an Ectopic Testis With Torsion: A Case Report. Cureus 16(8): e66008. doi:10.7759/cureus.66008