Crossed testicular ectopia: a rare case of knotting of the cords with testicular fusion

Abstract

left spermatic cord. After slight mobilization of the ectopic Case report right testis, a trans-septal orchidopexy was easily performed. Histopathological examination of tissue from A 21-year-old man presented with infertility and a past history of an unsuccessful inguinal exploration for right both testes showed maturation arrest. Because of the reported association of Mü llerian duct anomalies in such cryptorchidism. On clinical examination he had normal primary and secondary sexual characters except for an cases, he later underwent a laparoscopic examination, when none were found. empty right hemiscrotum. The left testis and the spermatic cord were bulky, which is not an uncommon finding in India as filariasis is endemic. He also had an Comment associated left indirect inguinal hernia. His semen examination showed azoospermia and the presence of fructose.Crossed testicular ectopia is a rare congenital abnormality and only 17 cases have been reported in the He underwent herniorrhaphy and a testicular biopsy, after which a scrotal exploration revealed that there medical literature over the last 15 years. There is no record of knotting of the spermatic cords with fusion of were two equal-sized testes firmly adherent to each other inside a single tunica vaginalis. Each testis had a separate the testes in any of these cases, although fusion of the vasa deferentia with or without duplication has been cord with a normal vas but the cords were tied in a loose knot (Fig. 1). Apart from an adhesion in a small reported in three [1]. The development of crossed testicular ectopia can be illustrated by reversing the operative area, the cords were otherwise completely free. The testes were easily separated by cutting the fibrous avascu-procedure. The orthotopic testis underwent a 180°torsion to form a loop in its cord. The ectopic right testis lar adhesions with scissors, with no damage to the tunica albuginea (Fig. 2). The spermatic cords were untied by with a 'clapper bell' deformity passed through this loop to form a knot, mimicking a method commonly practised passing the ectopic right testis through the loop of the by Gaur to form a laparoscopic knot [2]. The testicular a a d b c Fig. 2. The loop b, formed by the cord of the orthotopic testis a, Fig. 1. The fused testes with the knotted cords, just delivered from after the testes were separated. The cord d, of the ectopic right testis c, can be seen passing through the loop. the left scrotum. 924

A Rare Variation of Transverse Testicular Ectopia (TTE) in a Young Adult as an Incidental Finding during Investigation for Testicular Pain

“…Contrary to that, our case concerns a young adult without hernia. Gaur et al reported a successful transseptal orchidopexy in a 21-year-old azoospermic adult with two equal-sized fused testes but with two distinct separate spermatic cords and normal vas [16]. Yanaral et al did not perform a surgical correction in a 19-year-old azoospermic patient with fusion [3].…”

Case report: crossed testicular ectopia

“…The typical clinical scenario is an inguinal hernia with contralateral undescended testicle with the mean age at presentation of 4 years [1]. Discovery of crossed testicular ectopia is often intraoperative during herniorrhaphy with inguinal hernia being present in 41% of cases [2]. Gauderer et al [1] has described a classification system for crossed testicular ectopia based on the presence of associated abnormalities: type 1 (40%-50%) associated with inguinal hernia alone, type 2 (30%) associated with persistent or rudimentary müllerian duct structures, and type 3 (20%) associated with other genitourinary abnormalities without müllerian remnants.…”

Perspectives in Pediatric Pathology, Chapter 9. Alterations in the Number and Location of the Testis

“…Most cases are diagnosed during surgical repair of hernia or cryptorchidism [153][154][155][156][157][158][159][160][161][162]. Isolated cases have been diagnosed with incarcerated inguinal hernia [163] or testicular torsion [164][165][166]. However, other cases were incidentally diagnosed by sonography, computed tomography scan, or magnetic resonance imaging [165].…”