there are about 190 cases reported with higher prevalence of diagnosis in pediatric age group . with first histological confirmation in 1895
polyorchidism can clinically have varied presentations as inguinal swelling , cryptorchidism , testicular torsion , hydrocele and varicocele with majority being asymptomatic .
the most common form of polyorchidism is triorchidism ( or 3 testes ) with left sided predominance ( 65% ) over the right .
a higher tendency for malignant transformation in non - functional testis necessitates the radiological and functional assessment of polyorchid testes .
we hereby report a case of 24-year old male with left side super - numerary non - functional testis , presenting as left sided inguinal hernia .
a 24-year old young male came with reducible swelling in left inguinal region since 4 years without associated history of trauma or pain . on detailed local examination ,
a reducible swelling in the left inguinal region with positive cough impulse and positive deep ring occlusion test was noted .
the right testis was normal in size , whereas left testis was smaller in size 332 cm ( about 50% ) compared to the right side .
intraoperative findings of indirect inguinal hernia sac was present with small undescended super - numerary testis of size 2.52.51 cm at the deep inguinal ring ( figure 1 ) having short vas deferens and a normally located left testis with epididymis and vas deferens in the scrotal sac .
due to anomalous anatomy of super - numerary inguinal testis , orchidectomy with excision of indirect sac was performed .
the histopathological examination of the specimen reported thickened capsule of testis and tubules with arrest of development of the germ cells ( figure 2 ) .
a prominence of sertoli and leydig cells along with hyalinised , thickened basement membrane of seminiferous tubules and dense intervening stroma was found .
a follow up tumor marker assay showed negative study , which can likely be present in burned out tumor in spite of negative histology .
polyorchidism presents itself more commonly in the 2 to 3 decade , with approximately 50% of cases reported between 15 to 25 years of age .
the common presentations of polyorchidism manifests as maldescent ( 40% ) , hernia ( 30% ) , torsion ( 15% ) , hydrocele ( 9% ) , malignancy ( 6% ) , infertility and epididymitis .
the testis takes its origin from the medial part of primitive genital ridge while the epididymis and vas deferens develop from the wolffian duct .
the exact etiology of polyorchidism is unclear , however accidental division of genital ridge before 8 week of gestation could be a possible cause .
there are theories proposing the probable presence of multiple testes first being duplication of longitudinal genital ridge resulting into separate testes so total volume of testis exceeds of one .
the second theory explains transverse division of genital ridge at different levels resulting into different combination of testes , epididymis and vas deferens .
based on site of testes they can be classified as scrotal ( 66% ) , inguinal ( 23% ) and abdominal ( 9% ) .
leung ( 1988 ) classified polyorchidism based on embryological development with possible anatomical distinct epididymis or vas deferens . singer ( 1992 ) and colleagues proposed classification based on anatomical and functional potential of supernumerary testis to epididymis and finally by vas deferens .
an effort to restore the functionality of undescended testes can be attempted if surgically corrected before age of 4 - 5 years .
a significant risk of malignancy is reported in undescended non - functional testis before puberty being 2.2% while after puberty it rises substantially to 5.4% .
recent publications also suggest higher incidence of testicular malignancies ( 4 to 6% ) in cryptorchid testis compared to normal testis .
there is higher risk of testicular malignancy in polyorchidism cases of about 7% especially in non - scrotal testis . of these
the management of supernumerary testes has been a topic of much debate and different factors like age of patient , location of testes , functional status and lastly compliance and accessibility for follow up have to be taken into consideration .
broadly in pediatric age group or patients with reproductive desire and uncomplicated polyorchidism should have conservative approach like orchidopexy , however a strict vigilant follow up is mandatory . while adults without reproductive desire , complicated polyorchidism and with inaccessibility for follow up should not be considered for conservative management . in our view
supernumerary testis with complications like cryptorchidism , torsion and intraoperative non - functional testis i.e. , without a draining vas deferens or epididymis , excision can be performed due to higher risk of malignancy in polyorchidism . while conservative approach is recommended for uncomplicated polyorchidism in functional testis with a dedicated follow up .
current review of literature recommends conservative management for uncomplicated functional testes and regular follow up in polyorchidism .
a surgical approach is advisable in complicated , non - compliant and non - reproductive patients in view of higher risk of malignancy in these patients .
 triorchidism is the commonest variety of polyorchidism , an entity with more than two testis is an extremely rare congenital anomaly of the testis . 
 although excision of the abnormal testis is a safer alternative proposed , recent literature suggests more conservative approach in normal testes with watchful regular follow up to screen for malignancy . 
 this case presented as a left inguinal swelling diagnosed as indirect left inguinal hernia . 
 the left side testis was of smaller size ( about half ) with normal sperm count , morphology and motility . 
 intraoperatively indirect inguinal hernia was noted with supernumerary testis at deep ring in addition to normal left testis in left scrotal sac . 
 the ectopic testis were small ( 2.52.51 cm ) lacking epididymis and with short vas deferens . 
 an evident normal semen analysis and varied anatomy , the decision for orchidectomy of ectopic testis was taken . 
 the histopathological finding was consistent with arrest in germ cell development . 
Introduction
Case Report
Discussion
Conclusions