The patient in this case proceeded to urgent surgical exploration, where torsion of the left (main) testis was confirmed. The left (main) testis was detorted, resulting in return of good colour and appearance. The smaller supernumerary testis (separate spermatic cord) was not torted and had normal appearance. Orchidopexy was performed on both the left (main) testis and left supernumerary testis, as well as the right testis. The patient had an uneventful recovery and follow up period.
Polyorchidism is a rare congenital anomaly describing the presence of three or more testes. Left sided supernumerary testis is more common than right, and there is more commonly a single spermatic cord. Polyorchidism is asymptomatic, and commonly diagnosed incidentally with torsion, inguinal hernia, or testicular tumour. Undescended testis and microlithiasis are commonly present in association with polyorchidism1,2.
Testicular torsion is a time critical diagnosis, and if strongly suspected on clinical history/examination, the patient should proceed directly to surgical exploration and management, bypassing ultrasound. The role of ultrasound is in differentiation of equivocal presentations, where a diagnosis such as epididymo-orchitis is considered more likely. Even if no features of testicular torsion are demonstrated on ultrasound, an intermittently torting / untorting testis cannot be excluded3.