A baby boy born with "large and firm" testicles had managed to twist both of them inside the womb, in an "extraordinary" case that has baffled doctors and specialists so much that they decided to write about it in BMJ Case Reports.
Doctors from a hospital in Devon believe that it's irreversible and rules out all chances of the boy ever having children of his own, the report reveals.
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The condition – known as bilateral testicular torsion – has been recorded in just a handful of cases, where the infant crippled both his testicles in the womb. As Daily Mail Online reported, it strikes six in every 100,000 children, and even then most of them are unilateral, meaning, only one testicle gets affected.
It is a rare disorder that mostly affects boys around puberty. It needs to be treated as an emergency, with surgeons untwisting the testicle via a small cut in the skin of the scrotum.
It can happen during physical activity when the tissue surrounding the testicles is not firmly attached to the scrotum. It can also occur when a man is asleep.
Pulling the spermatic cord along with it, the torsion cuts off blood supply to the testicles, causing the testicle to "die" after six hours, and will then need to be removed.
Dr Richard Viney, a consultant urological surgeon at The Bladder Clinic, Birmingham, believes that the boy's chances of having children in the future are "stuffed".
"[At this age] testes haven't developed to the point of manufacturing sperm," he told Daily Mail Online.
But, even though he claimed it's a "shame for the kid," he added that there is also a slight hope that the boy's testicles could "spontaneously untwist".
Writing in the journal, experts at the Royal Devon and Exeter Hospital shared that a "male neonate" was initially noted to have "large and firm testicles on routine examination".
They added: "Neonatal torsion is almost always unilateral and only a few cases of bilateral in utero torsion as in this case have been described. For a baby to be born and by a few hours of age have irreversible torsion of both testicles simultaneously is very rare."
Baby's discomfort puzzled doctors
Delivered by midwives at the Royal Devon and Exeter Hospital after 36 weeks of gestation, the baby weighed a healthy 8lbs 13oz, and had shown no signs of the issue in scans throughout the pregnancy. Apart from his neck wrapped by the umbilical cord, there was hardly any medical help required at the time of his birth.
However, things changed an hour after birth, when the baby started breathing abnormally fast. His grunts prompted concern from doctors. He was immediately rushed to the neonatal care unit, where doctors initially assumed that he had sepsis and even gave him antibiotics for it.
Further evaluation revealed that it wasn't a case. Because the baby "never showed signs of distress", as well as no family history of the condition being recorded, they kept ruling out the possibility of torsion, said the report.
Continued uncertainty regarding his condition eventually led to a testicular ultrasound on the third day after he was born, and specialists explained that the scan was "sadly consistent" with bilateral testicular torsion, meaning blood supply was cut off to both.
With both testicles being full of fluid and "irregular in outline", an added lack of any vascular flow helped them confirm that these were signs of testicular torsion. Urologists believe that the twisting had occurred in utero and surgery wasn't a possibility.
As part of treatment, the doctors decided to let his non-functioning testicles curl naturally, in the hopes that they may untwist on their own.
Being also low on testosterone levels, the baby was started on testosterone replacement therapy and it is now hoped that the treatment will allow him to develop normally.