Triorchidism diagnosed during a routine hernia repair: A case report and literature review.

Abstract

Introduction: Triorchidism is a rare anomaly whose management raised considerable discussion. Several factors must be considered, including the patient's age, the testes location, their functional status, and the accessibility and compliance for follow-up. We present a case of triorchidism diagnosed incidentally during a routine hernioplasty procedure, serving educational and informative purposes.

Case report: A 44-year-old patient, presented with uncomplicated bilateral inguinal hernias with both testicles in place. During surgery, a supernumerary testicle was discovered in the inguinal region. It was decided to preserve the testicle since the patient agreed to strict and vigilant follow-up.

Discussion: Supernumerary testis may have a scrotal, inguinal, or abdominal location. The exact etiology of polyorchidism is unclear, however accidental division of the genital ridge before 8 weeks of gestation could be a possible cause. There are various types of classifications for polyorchidism, which is made on imaging in 80 % of the cases and incidentally in 20 % of the cases. In young patients in reproductive age, orchidopexy is recommended if feasible, followed by careful observation. This monitoring is supported by the high sensitivity and specificity of imaging techniques. The situation is more intricate when the supernumerary testis is incidentally discovered and is associated to cryptorchidism, known to increase malignancy risk. These situations raise the question whether to perform orchiectomy per-operatively.

Conclusion: Polyorchidism is a rare pathology with only few cases reported in the literature. Due to the lack of consensus and the high resolution of imaging sensitivity and specificity, management tends to be conservative.