Incidental detection of three testes while evaluating an empty left scrotal sac: a case report.

Introduction and importance: Poly-orchidism is a rare congenital anomaly of the genitourinary system, which is characterized by the presence of more than two testicles, also being termed as "supernumerary testis". Tri-orchidism is the most frequently encountered form of poly-orchidism, which is defined as the presence of more than two intra- or extra-scrotal testicles.

Case presentation: The authors present a case of a 16-year-old male who presented with a complaint of an empty left scrotal sac, and was later diagnosed as a case of tri-orchidism with each testis in bilateral hemipelvis confirmed by ultrasound with Doppler and MRI. The patient was kept in regular follow-up for 6 months with radiological assessment, which showed no changes in radiological findings as before.

Clinical discussion: The majority of patients are asymptomatic or present with a painless inguinal or scrotal mass, undescended testis, and rarely torsion of the supernumerary testis. Imaging modalities like US, Doppler study, and MRI are required for the diagnosis. Non-scrotal location of poly-orchidism is considered as the most important risk factor for malignancy. The surgical approach is required for any malignant changes in biopsy, US showing features of malignancy, absent spermatogenesis or in cases where regular follow-up is not possible. Otherwise, a conservative approach with regular follow-up is enough if above indications are absent.

Conclusion: The complications of poly-orchidism like undescended testes, inguinal hernia, infertility, and possibly malignancy must be borne in mind while diagnosing poly-orchidism. The above-mentioned aspects must also be considered while choosing surgical intervention versus a conservative approach with follow-up, depending upon the position of the supernumerary testicle being scrotal or ectopic.