Transverse testicular ectopia with Müllerian duct remnant in an incarcerated congenital inguinal hernia – a case report

Abstract

Background: Transverse testicular ectopia (TTE) is a rare anomaly characterized by both testes descending through a single inguinal canal. In this report, the diagnosis of TTE was discovered in the event of an incarcerated congenital inguinal hernia in a neonate. Case presentation: We present a case of TTE accompanied by persistent Müllerian duct structures (PMDS) that had been discovered incidentally during inguinal exploration of a 26-day-old boy who presented with an incarcerated congenital inguinal hernia on the right side and left cryptochidism on the left side. The pathogenesis, approach and proposed management of TTE are discussed. Conclusion: TTE is an extremely rare anomaly, especially in neonates, and should be suspected in patients presenting with inguinal hernia on one side and cryptorchidism on the other side.

Diagnostic value of ultrasound in children with transverse testicular ectopia

“…The volume of the testis on the affected side and contralateral side of TTE measured by ultrasound were 0.33 ± 0.10 and 0.37 ± 0.10 cm 3 . The volume of the affected side testis was smaller than that of the contralateral testis ( P < 0.05), which was consistent with the results of previous studies ( 5 ). When the testis was associated with by atrophy, torsion, and malignant transformation, the intraparenchymal echo may be inhomogeneous, showing flaky hypoechoic and liquefied anechoic areas ( 18 – 20 ).…”

“…Persistent Müllerian duct syndrome is a very rare pathological association with TTE. PMDS is a rare male pseudohermaphroditism, which refers to the continuous development of Müllerian ducts due to the lack of Müllerian inhibiting factor (MIF) or anti-Müllerian hormone (AMH) during embryonic development in male individuals with normal genotypes, and further differentiates into the uterus, fallopian tubes, and upper vagina ( 5 ). In children with PMDS, the lack of MIF can lead to obstruction of testicular descent.…”

“…The surgical methods for TTE include transscrotal mediastinal orchiopexy (Ombredanne operation), orchiopexy, extraperitoneal orchiopexy, bilateral testes fixed in the same hemiscrotum, Fowler-Stephens orchiopexy, testicular transplantation surgery, and orchiectomy ( 5 , 7 ). Transscrotal mediastinal orchiopexy is the most commonly used procedure for TTE.…”

“…Previous studies have suggested that the occurrence of TTE is related to persistent Müllerian duct syndrome (PMDS) (4)(5)(6). Children with TTE often present with a scrotal emptiness or a groin mass.…”