Intra-abdominal testicular torsion in an adult male: A rare mimic of appendiceal abscess on CT

Torsion of an intra-abdominal undescended testis is an exceptionally rare cause of acute abdomen in adults and may mimic more common conditions such as appendicitis or pelvic abscess. We present a 28-year-old man with fever and right lower quadrant pain, leukocytosis, and an empty right hemiscrotum. CT revealed a large nonenhancing hypogastric mass with a twisted pedicle, and laparotomy confirmed torsion of a necrotic intra-abdominal testis. Histopathology showed hemorrhagic necrotizing orchitis without malignancy. This case highlights the importance of considering intra-abdominal testicular torsion in adult males with acute abdomen and a nonpalpable testis, and demonstrates the diagnostic value of identifying a twisted pedicle on cross-sectional imaging to avoid delay and misdiagnosis.