Abstract
Introduction: Cryptorchidism is defined as a testicle located outside the scrotum. These undescended gonads are often found along the path of testicular descent. Testicular torsion occurs when the spermatic cord rotates upon itself leading to acute decreased or absent blood flow to the testicle. The literature of testicular torsion associated with cryptorchidism in the pediatric population was first described by Delasiauve in 1840 with limited case reports, case series, and small retrospective reviews since then. The actual incidence of testicular torsion with cryptorchidism in post-pubertal pediatric patients remains unknown due to the extremely limited published literature on the topic.

Case Description: Here we present the case of a testicular torsion of an undescended inguinal testicle of a post-pubertal male who presented with three days of worsening right lower quadrant abdominal and right inguinal pain associated with worsening bulging of the right inguinal canal and erythematous changes to the area. Ultrasonography revealed torsion of the right testicle with diffuse abnormally low echotexture, trace hydrocele, overlying scrotal wall thickening with edema, an enlarged right epididymis with heterogenous echotexture, and absent arterial blood flow by Doppler. The patient underwent emergent inguinal exploration, right inguinal orchiectomy, and concomitant scrotal exploration, and left testicular fixation. Pathology was consistent with a diffusely hemorrhagic and infarcted testicle consistent with testicular torsion, negative for malignancy.

Discussion: Further research into presentation, diagnostic acumen, and awareness of this rare but consequential condition is warranted for referring providers and caregivers to decrease devastating results such as testicular necrosis and orchiectomy.