Acquired canalicular cryptorchidism mimicking testicular torsion following neonatal herniotomy: a rare cause of acute paediatric groin pain

We report a rare case of an 11-year-old boy presenting to a rural Australian hospital with acute left groin pain, a history of extreme prematurity, and bilateral inguinal herniotomies in infancy. Examination revealed a firm, tender, irreducible mass in the left inguinal canal and an empty left hemiscrotum. The right testis was retractile and non-tender. Doppler ultrasound showed absent blood flow to the left testis, prompting urgent surgical exploration. Intraoperatively, the testis was incarcerated within the left inguinal canal amid dense post-surgical adhesions. After adhesiolysis, the testis was viable and mobilized for tension-free orchidopexy via a subdartos pouch. The contralateral testis was also fixated. We hypothesize acquired canalicular cryptorchidism due to post-herniorrhaphy scarring causing vascular compromise from extrinsic compression. This rare mimic of torsion underscores the importance of recognizing atypical presentations of a threatened testis and demonstrates timely surgery is feasible in rural settings with remote specialist support.