Snapshots in surgery: incidentally discovered cryptorchidism

Question: An 18-year-old male presented to the emergency department with a 12-h history of abdominal pain and a 2-day history of anorexia and abdominal cramps. Vital signs were T 37.1°, BP 137/88, RR 18, and HR 88. Physical examination revealed right iliac fossa guarding, rebound tenderness, and a positive Rovsing's sign. A clinical diagnosis of appendicitis was made. What is the incidental finding shown in this intraoperative photograph?

Answer: A large inflamed appendix (compressed by the instrument) and a spermatic cord with right undescended testicle (cryptorchidism). The case was converted to open due to concern of an appendiceal mucocele.

Scrotal examination revealed a normal left testicle and a pea-sized mass on the right side. Histologic evaluation of the appendix showed acute appendicitis with transmural inflammation. An interval orchidectomy was performed after appropriate counseling. Patients who undergo orchiopexy after age 12 years, or no orchiopexy, are 2 to 6 times as likely to have testicular cancer as those who undergo prepubertal orchiopexy 1.

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Conflict of Interest

None declared.