Ruptured Seminoma of Undescended Testis Presenting as Acute Abdomen: Case Report with Literature Review
A 28-year-old man was admitted in the emergency department, with the chief complaint of sudden, severe, continuous abdominal pain of one day duration that was precipitated by lifting a heavy load. Initially, pain was localized to the right lower abdomen, but later became diffuse in nature. He had no past history of surgery or any other disease. On admission, his blood pressure was 110/70 mmHg, and his pulse rate was 106 beats/min. There was generalized abdominal tenderness with guarding and rigidity. His plain chest roentgenogram showed no abnormality. Abdominal radiograph taken in the erect posture did not show any free air under domes of diaphragm. His hemoglobin concentration was 10.8 g/dL, and the white blood cell count was elevated to15,000/mm3. Provisional clinical diagnosis of acute appendicitis with perforation was made. Scrotal examination and tumoral markers were not done. Ultrasound abdomen revealed a significant amount of free fluid with echoes in peritoneal cavity and an echogenic organized fluid collection in pelvis suggesting a hematoma. Solid viscera were normal. No evidence of appendicular pathology was seen. Fluid resuscitation was started immediately. Contrast-enhanced computerized tomography scan was done 12 h after admission, which, in addition to depicting the large pelvic hematoma, showed a suspicious pelvic mass with active bleeding and significant high-density ascites []. Rest of the scan was unremarkable. The patient was immediately moved to the operating room. At laparotomy, there was about 4000 mL of mixed free and clotted blood. In the right iliac fossa, an actively bleeding testicular mass, 7 cm × 7 cm in size, which was ruptured at the superior pole was found. The mass was excised []. No other mass was found and the solid viscera, mesentery and intestines were found to be normal. Post-operative management included regular monitoring of vitals, IV fluids, antibiotics and dressings. The post-operative period was uneventful. The patient was discharged 7 days after the operation. Histopathological examination proved the mass to be a testicular seminoma.