Fujii Takayuki, Satoh Hiroyuki, Sato Atsuko, Ishizuka Yoshiaki, Izawa Mizuki
Department of Urology, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, JPN.
Department of Pediatric Surgery, Kagawa University, Takamatsu, JPN.
Cureus. 2024 Aug 2;16(8):e66008. doi: 10.7759/cureus.66008. eCollection 2024 Aug.
Since ectopic twisted testes are a rare condition, correctly and opportunely diagnosing them preoperatively is difficult and can result in testicular necrosis. We report a clinical case of a twisted ectopic testis that was diagnosed preoperatively by ultrasonography, and the testis could be rescued. A generally healthy 13-year-old boy was referred to our Urology Department after experiencing a painless swelling in the left inguinal region two weeks before, and mild exercise-induced pain in the same area one week before the referral. The mild pain persisted without worsening. On examination, a mildly tender swelling was present in the left inguinal region. The left half of the scrotum was empty; however, the right testis was normal in size and position. Ultrasonography revealed that the left spermatic cord was present within the inguinal canal and was directed superficially, with spiral twisting. The left testis was located above the inguinal canal, with normal echogenicity, but was smaller than the right normal testis (right testis, 41 × 28 × 16 mm; left testis, 18 × 18 × 8 mm). Power Doppler ultrasound showed normal blood flow in the left testis. Consequently, we diagnosed an ectopic testis with torsion. Intraoperative examinations confirmed the presence of the testis in the left superficial inguinal pouch. Although the testis had twisted five and a half turns (1980°) clockwise at the level of the superficial inguinal pouch, ischemia was not evident. Orchidopexy of both testes was performed, and the left testicular size was maintained after surgery. If swelling is present in the inguinal region and no testis is found in the scrotum, an ectopic testis should be considered in the differential diagnosis. Preoperatively diagnosing an ectopic, twisted testis by ultrasonography alone is difficult. However, we used ultrasonography effectively to diagnose the ectopic testis preoperatively by tracking the spermatic cord and confirming the torsion of the testis.
由于异位扭转睾丸是一种罕见病症，术前正确且及时地诊断很困难，可能导致睾丸坏死。我们报告一例通过超声术前诊断出的扭转异位睾丸临床病例，该睾丸得以挽救。一名总体健康的13岁男孩，在两周前左侧腹股沟区出现无痛性肿胀，转诊前一周该区域在轻度运动时出现疼痛，随后被转诊至我们的泌尿外科。轻度疼痛持续未加重。检查发现左侧腹股沟区有轻度压痛性肿胀。阴囊左侧空虚；然而，右侧睾丸大小和位置正常。超声检查显示左侧精索位于腹股沟管内，走向浅表，呈螺旋状扭转。左侧睾丸位于腹股沟管上方，回声正常，但比右侧正常睾丸小（右侧睾丸，41×28×16mm；左侧睾丸，18×18×8mm）。能量多普勒超声显示左侧睾丸血流正常。因此，我们诊断为异位睾丸扭转。术中检查证实睾丸位于左侧浅表腹股沟袋内。尽管睾丸在浅表腹股沟袋水平顺时针扭转了五圈半（1980°），但未见明显缺血。对双侧睾丸进行了睾丸固定术，术后左侧睾丸大小得以维持。如果腹股沟区出现肿胀且阴囊内未发现睾丸，鉴别诊断时应考虑异位睾丸。仅通过超声术前诊断异位扭转睾丸很困难。然而，我们通过追踪精索并确认睾丸扭转，有效地利用超声术前诊断出了异位睾丸。
