Torsion of Undescended Testis in a 14-Month-Old Child Refusing to Bear Weight

Abstract

In this report, we discuss a case of a 14-month-old male presenting in the emergency department with refusal to bear weight on his left leg. Plain radiographic studies revealed no evidence of effusion, fracture, or dislocation. Laboratory studies were significant for an elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. Further studies included unremarkable ultrasound of the left hip and normal magnetic resonance imaging (MRI) of both hips. An incidental finding on MRI was a left inguinal mass concerning an incarcerated hernia. Ultrasound of this mass demonstrated a left undescended testis within the inguinal canal and possible incarcerated paratesticular inguinal hernia. The final pathologic diagnosis of a torsed gangrenous left testicle within the inguinal canal was confirmed during surgery.

Perspectives in Pediatric Pathology, Chapter 14. Natural History of Undescended Testes

“…According to some studies, the contralateral testis should be fixed by orchidopexy if suspensory anomalies are observed [202]. The number of testes that can thus be preserved is low because of delays in diagnosis [203][204][205]. Adult testes that were fixed by orchidopexy show calcifications in the tunica albuginea at the point of fixation.…”

Limping Child? Think LIMPSS

“…Although the list of pathologies that can cause referred pain to the legs or hip is "painfully" long, some that have been known to present this way include psoas abscess, appendicitis, discitis, urinary tract infection, ectopic pregnancy, torsion (of the ovarian or testicular variety), and pelvic inflammatory disease. 18,[28][29][30] Most of these diseases cause referred pain through irritation of the iliopsoas or obturator internus muscles or obturator nerve, which innervates to the distal thigh and knee. Just remember that it's never normal for a child to be limping.…”