Type D Polyorchidism as an Incidental Finding in an Adult with an Indirect Inguinal Hernia: A Case Report.

Abstract

Background: Polyorchidism (supernumerary testis) is an extremely rare congenital anomaly of three or more testes. Bergholz et al reported that ~65% occur on the left side, with a median patient age of 17 years.

Case presentation: A 27-year-old man presented with a gradually enlarging right inguinal swelling and mild discomfort. Clinical examination revealed a right indirect inguinal hernia, two testes in the right hemiscrotum, and one on the left. Color Doppler ultrasound confirmed the hernia and polyorchidism, and also showed mild left varicocele (grade I). The patient underwent elective right inguinal exploration. Intraoperatively, an indirect hernia sac was isolated and ligated. Two separate right testes were found: the superior (supernumerary) testis was smaller but had its own epididymis, vas deferens, and viable blood supply. Hernia repair with mesh and right orchiopexy were performed successfully. Postoperative recovery was uneventful. A strict follow-up protocol (clinical exam + Doppler ultrasound every 6-12 months) was established. Fertility was preserved; the patient is married with three children, contrasting with reports of potential male infertility.

Case discussion: Polyorchidism in a 27-year-old undergoing elective inguinal hernia repair is uncommon. Ultrasound with Doppler is the first-line evaluation. Management should be individualized based on anatomy, imaging, and fertility.

Conclusion: Conservative management with orchiopexy of viable, scrotal, non-suspicious testes is preferred. Surgical orchiectomy is reserved for non-viable tissue.