Missed cryptorchidism, missed time: a diagnostic pitfall in adolescent testicular torsion - A surgical emergency

Torsion of an undescended (cryptorchid) testis is rare but represents a true urological emergency. Because symptoms may be atypical and scrotal signs can be absent, diagnosis is frequently delayed, resulting in a higher risk of testicular loss. A 16-year-old adolescent with a history of untreated cryptorchidism presented approximately 10 hours after symptom onset with acute inguinal pain. General examination showed no associated infectious signs. Urgent color Doppler ultrasound identified an intra-inguinal undescended testis with absent intratesticular vascular flow, consistent with acute torsion of the spermatic cord in a cryptorchid testis. The patient underwent surgical exploration approximately 30 minutes after ED arrival (total ischemia time ~11 hours). Intraoperatively, the spermatic cord was found to be torsed 360°; the testis appeared ischemic/necrotic and remained non-viable despite detorsion and rewarming with warm saline-soaked gauze for 15 minutes, leading to orchiectomy. Torsion of an undescended testis must be considered in any boy/adolescent presenting with acute inguinal pain and an empty hemiscrotum. Prompt recognition and urgent exploration are essential. This case also highlights the importance of early management of cryptorchidism to prevent avoidable complications and delayed diagnosis.