Ischemic Orchitis, an Unusual Sign of Abdominal Aortic Aneurysm with the Risk of Tearing: A Case Report and Review of the Literature

Abdominal Aortic Aneurysm (AAA) represents an important public health problem because of its prevalence and very high mortality associated with rupture. Timely diagnosis and treatment are essential to reduce the mortality rate associated with this disease.

A 69-year-old man referred to our center because of severe left testicular pain and distal abdominal pain from two days ago. During examination, he had a non-expanding palpable mass in his lower abdomen with hypogastric tenderness and severe tenderness in the left testicle. On the initial evaluation, his systolic blood pressure was 160 mmHg, his diastolic blood pressure was 70 mmHg, and his heartbeat was 100 beats per minute. Hematocrit, hemoglobin, and creatinine concentrations were 32%, 10 g/dL, and 2.4 mg/dL, respectively. In addition, tumor markers such as Lactate Dehydrogenase (LDH), Alpha-Fetoprotein (AFP), and Beta Human Chronic Gonadotropin (BHCG) were negative in his preoperative laboratory tests. During the abdomen and pelvis ultrasound, an infrarenal abdominal aortic aneurysm with a diameter of 8 cm and a hyperheteroecho and isovascular mass measuring 35 * 22 mm were detected in the left testicle. Mass or infarction following embolization was in the differential diagnosis. The patient was candidate for an emergency operation. AAA was repaired by aortobifemoral bypass surgery and left orchiectomy was done through a left inguinal incision. The left testicle specimen pathology report was ischemic orchitis, which might have resulted from the emboli of the aortic aneurysm to the testicle.

Aortic aneurysm with the risk of rupture could present with some unusual symptoms, such as testicular pain, and every surgeon should be aware of this symptom for early diagnosis and treatment.