Ipsilateral polyorchidism with cryptorchidism in a pediatric patient: a rare case report from a resource-limited setting.

Background: Polyorchidism with cryptorchidism is an extremely rare congenital anomaly, particularly in children. Diagnosis and management are significantly more complex in low-middle-income countries (LMICs) due to resource limitations, including absent laparoscopy, increasing risks of torsion, malignancy, and infertility.

Case presentation: An 8-year-old male from an LMIC presented with a non-palpable left testis. Preoperative ultrasonography detected an atrophic left intra-abdominal testis but missed a supernumerary testis. Mandatory open exploration (laparoscopy unavailable) revealed two left testes: one severely atrophic/hypoplastic (removed via orchiectomy) and a smaller viable cryptorchid testis (preserved via orchiopexy). Histopathology confirmed benign atrophy.

Discussion: In LMICs, reliance on open surgery increases diagnostic/therapeutic challenges. Intraoperative discovery of the supernumerary testis underscores the need for meticulous surgical exploration despite inconclusive imaging. Orchiectomy of the atrophic testis highlights balancing endocrine preservation against malignancy risk. Embryologically, this may result from incomplete transverse division of the genital ridge or aberrant regression. Long-term endocrine follow-up and germinal surveillance are critical, especially amidst resource constraints.

Conclusion: Managing concurrent polyorchidism and cryptorchidism in LMICs requires adapted strategies when advanced techniques are inaccessible. Open surgery remains vital diagnostically and therapeutically, necessitating vigilance for supernumerary testes. This case exemplifies balancing orchiectomy for non-viable tissue with orchiopexy for functional preservation, advocating context-sensitive surgical approaches in resource-limited pediatric urology.