When Hernia Isn’t a Hernia: Testicular Torsion of an Ectopic Gonad Mimicking Incarcerated Inguinal Hernia: Case Report

¹ETTAOUSSI Abdelhak, ²JAMALEDDINE Khalid, ³AHED Youssef, ⁴KAMAL Khadija, ⁵MAJD Abdessamad, ⁶BOUALI Mounir, ⁷ELBAKOURI Abdelilah, ⁸EL HATTABI Khalid

^{1,2,3,4,5,6,7,8}Department of general surgery, IBN ROCHD University hospital of Casablanca, Casablanca, Morocco

Corresponding author: JAMALEDDINE Khalid

DOI: 10.58806/ijhmr.2025.v4i10n02

ABSTRACT

Introduction: Inguinal swellings in children and young adults are frequently diagnosed as hernias or hydroceles. However, rare conditions can present with nearly identical symptoms, leading to potential misdiagnosis and severe outcomes. We report a critical case of testicular torsion in an intra-abdominal undescended testis that clinically mimicked an incarcerated inguinal hernia.
Case Presentation: A 20-year-old man with a history of bilateral cryptorchidism and cerebral palsy presented with a painful, irreducible right inguinal swelling and vomiting. Preoperative ultrasonography was performed. Despite imaging, a diagnosis of incarcerated inguinal hernia was made. Urgent surgical exploration revealed a necrotic, torsed testis within the inguinal canal, necessitating orchidectomy.
Discussion: This case highlights a significant diagnostic pitfall. Torsion of an undescended testis can perfectly mimic an incarcerated hernia. Cognitive anchoring bias likely contributed to the misinterpretation of preoperative ultrasound findings. The absence of the testis in the scrotum is the most crucial clinical clue that must trigger suspicion for torsion.
Conclusion: Torsion of an ectopic testis must be a primary consideration in any male with a tender, irreducible inguinal mass and cryptorchidism. The physical exam finding of an empty scrotum should override ambiguous imaging results. A high index of suspicion is essential for testicular salvage.

KEYWORDS

Testicular Torsion; Ectopic Testis; Cryptorchidism; Inguinal Hernia; Diagnostic Error; Cognitive Bias; Case Report.

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