Case Report
A 16-year-old boy with a history of polyorchidism presented to our hospital
with a 2-day history of left testicular and inguinal pain. He denied a history
of scrotal trauma, and the patient did not feel any discomfort previously
with the history of polyorchidism. On physical examination, the left side of
the scrotum was markedly red and swollen, and two masses were identified
in the left hemi-scrotum. The higher mass was painful, hard on palpation,
and elevated compared to the right testicle. The lower mass was palpable in
the left hemi-scrotum. The left cremasteric reflex was significantly
diminished. After admission, his blood work was completed: leukocytes
(7,620/μl), hemoglobin (16 g/dl), platelets (303,000/μl), LDH (173 co/L),
HCG (1.2 mIU/ml), and AFP (2.15 ng/ml).
An ultrasonography scan of the scrotum revealed two hypoechoic masses,
both with testicular-like textures. The higher mass, measuring 3.1 × 2.0 cm,
did not have visible vascular flow inside on color Doppler examination
(Figures 1C,D); the lower mass, measuring 1.9 × 1.5 cm, had visible
vascular flow (Figures 1A,B). Based on the outcomes of physical
examination and ultrasound, the patient was diagnosed with polyorchidism
and testicular torsion in the left hemi-scrotum. Therefore, emergency
scrotal exploration was performed under spinal anesthesia. The patient's
parents were informed of the possibility of orchiectomy in surgery.
Figure 1
FIGURE 1. Color Doppler image: Two testicles were lying in the left hemi-
scrotum. The lower testicle=(A)=is smaller than the higher testicle=(C)=and
has normal blood flow=(B). There is no visible vascular flow in the higher
testicle=(D).
During operation, we found that two testicles were lying within the single
tunica vaginalis. The upper left testicle was black and twisted 360°
clockwise. The lower left testicle was normal in its color. On gross
examination, the two testicles share the same vas and two separate
epididymites (Figure 2). Detorsion was performed on the black testis; after
15 min of observation, the testicle color was not changed obviously. No
