Intra-Abdominal Testicular Torsion as a Cause of Acute Abdominal Pain in Patient with Silver-Russell Syndrome: First Case of Robot-Assisted Laparoscopic Surgical Exploration with Orchidectomy

Abstract

Introduction and Background: Silver-Russell syndrome is a rare genetic disorder, occurring in ∼1/50,000 to 1/100,000 births. Anomalies of the urogenital tract such as hypospadias and cryptorchidism can be present. Testicular torsion is a urologic emergency that is most common in prepubertal boys. In patients with cryptorchidism, it can present with abdominal pain and nonspecific symptoms and can mimic other intra-abdominal emergency conditions. Case presentation: A 21-year-old man presented in emergency room at our hospital with acute right lower abdominal pain. Abdominal ultrasonography excluded acute appendicitis, atypical mass on the right side of the bladder was identified. Later, he reported history of inguinal exploration caused by undescended right testis in infancy where testis was not found, and Silver-Russell syndrome. Contrast-enhanced abdominal CT scan revealed an atypical mass on the right side of the bladder, suspicious for torsion of undescended testis, or tumor. Tumor markers for testicular cancer were negative. The patient underwent robot-assisted laparoscopic orchidectomy for torsion of undescended intra-abdominal testis. Histopathologic examination excluded malignancy. Conclusion: Testicular torsion should be considered as the cause of acute abdominal pain in patients with undescended testis and rare genetic disorders. Robot-assisted laparoscopic surgical exploration has the advantage of better exposure and visibility and should be considered in such cases.

Keywords: Silver–Russell syndrome; acute abdominal pain; robot-assisted orchidectomy; testicular torsion; undescended testis.