Testicular torsion of an undescended testis with incidental ipsilateral polyorchidism in a septuagenarian: a case report

Introduction and importance: Polyorchidism is a rare congenital anomaly characterized by the presence of more than two testes. Although most cases are diagnosed during childhood or early adulthood, presentation in elderly patients is uncommon. Testicular torsion involving an undescended testis is also unusual in this age group. We report an exceptionally rare case of torsion of an undescended testis with incidental ipsilateral polyorchidism in a septuagenarian. Case presentation: A 70-year-old man presented with acute left inguinal pain and swelling of 2 days duration. Clinical examination revealed an empty left hemi-scrotum and a tender inguinal mass. Ultrasonography suggested torsion of an undescended testis. Emergency inguinal exploration identified a torsed, enlarged, non-viable testis near the superficial inguinal ring. A second, smaller testicular structure was incidentally identified near the deep inguinal ring on the same side. High inguinal orchidectomy was performed. Histopathology confirmed two distinct testicular tissues, consistent with ipsilateral polyorchidism, with infarction in the torsed specimen and no malignancy. Clinical discussion: This case highlights the diagnostic challenge of testicular torsion in elderly patients presenting with acute groin pain. An empty ipsilateral hemiscrotum should prompt consideration of an undescended testis, even in advanced age. Management of a supernumerary testis should be individualized based on age, location, viability, malignancy risk, and reproductive considerations. Conclusions: Torsion of an undescended testis with ipsilateral polyorchidism is exceptionally rare in elderly patients. Careful clinical examination and meticulous exploration are important for identifying associated congenital anomalies and guiding appropriate management.