A rare content of congenital inguinal hernia: a case report of splenogonadal fusion

Abstract

BackgroundSplenogonadal fusion (SGF) is a rare congenital malformation that occurs during embryonic development. SGF typically presents as a left-sided scrotal swelling, left inguinal hernia, scrotal mass, or cryptorchidism. Therefore, it is easily misdiagnosed, and unnecessary orchiectomy may occur. This study aimed to report a rare case of SGF.Case presentationA 5-month-old male child presented with a history of obvious left scrotal swelling for 1 month, which progressively worsened 10 h before the hospital visit. The ultrasound examination exhibited a solid mass in the left scrotum, with echo quite similar to that in the testicle and went up into the abdominal cavity through an identical echogenic band structure. After surgical resection, the pathological examination confirmed that the submitted tissue was spleen tissue with extensive bleeding.ConclusionUltrasound can provide important information regarding the diagnosis of SGF. The possibility of SGF should be considered for further differential diagnosis in the case of similar patients.

Acute lymphoblastic leukaemia presenting as paediatric priapism

“…Majority (70%) of these patients present before 20 years of age and 50% are found before the age of 10 years [5,8]. The usual mode of presentation in children is an undescended testis or inguinal hernia [9][10][11]. If palpable it may be diagnosed preoperatively as a testicular mass.…”

“…Among the impalpable intra-abdominal cases, especially when laparoscopy is done, mass of splenic tissue attached to the upper pole of testis, with or without connection to the main spleen, may be seen [8,11]. Other modes of presentation include painless scrotal lump and acute scrotum [10][11][12][13]. In adults it usually present as a testicular mass, or investigations for infertility raising the alarm for testicular tumor [11,14].…”

Splenogonadal fusion: a case report and review of the literature

“…Continuous SGF (55% of cases) is characterized by the presence of a cord of splenic or fibrous tissue connecting the spleen and gonad, and occasionally beads of splenic tissue could be found along the cord (splenic rosary bead), while in discontinuous SGF (45% of cases), there is no such connection. Rather, in discontinuous SGF, ectopic splenic tissue or accessory spleen is directly attached to the gonad without connecting to the native spleen [2,3,5,7,10]. During embryonic development, the descent of the testis could sometimes draw out the developing spleen fused to the testis into a long band (Continuous SGF) or to carry a portion of the splenic primordium down with the descending testis (Discontinuous SGF) [7].…”

“…Rather, in discontinuous SGF, ectopic splenic tissue or accessory spleen is directly attached to the gonad without connecting to the native spleen [2,3,5,7,10]. During embryonic development, the descent of the testis could sometimes draw out the developing spleen fused to the testis into a long band (Continuous SGF) or to carry a portion of the splenic primordium down with the descending testis (Discontinuous SGF) [7]. 19 (46.34%) of the 41 cases in our study were continuous, and 23 (53.65%) cases were discontinuous (Table 1).…”

“…SGF is a condition that usually presents as inguinal hernia, cryptorchidism, or scrotal swelling/mass, and it could be misdiagnosed as testicular malignancy and leads to unnecessary, life-altering orchiectomy [2,7,12,13]. Lack of awareness of this condition is a major reason for its misdiagnosis [2,7,12,13]. SGF cases that present as cryptorchidism are often treated with single stage laparoscopic Fowler-Stephen orchiopexy [11,30,32].…”