Mrinal Arora1, Jaswinder Kaur2, Rajeev Kulshreshtha1. 1. Department of Pediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India. 2. Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India.
Sir,Transverse testicular ectopia (TTE) or testicular pseudo-duplication/unilateral double testis/transverse aberrant testicular mal-descent is a rare anomaly in which both the testes descend through a single inguinal canal and lie in the same hemiscrotum. In the literature, less than 100 cases of TTE have been reported.[1] A 9-year-old boy was admitted with the chief complaint of bilateral empty scrotum since birth. He was operated elsewhere at the age of 2 years. As per parents, right-sided inguinal exploration was done, but testes could not be localized. Operative records were not available. When the child presented to us, he had an oblique surgical scar in the right inguinal region. There was no scar in the scrotal region. Scrotum was empty and poorly formed on both sides. Testis was palpable in the right inguinal region and no testis was palpable in the left scrotum or the left inguinal region. Ultrasound of the local region revealed the presence of both the testes in the right inguinal region and absence of any Mullerian structures. The child was posted for right inguinal exploration and bilateral orchidopexy. Right-sided inguinal exploration was done through the previous surgical scar. On exploration, both the testes were found in the right inguinal canal, attached to each other with separate cord structures [blood vessels and vas deferens, Figure 1]. The testes along with the cord structures were separated. There were thick fibrotic attachments between the spermatic cords. The cords were separated up till the deep inguinal ring. The proximal testis was placed in the right hemiscrotum and the distal testis was placed in the left hemiscrotum, through an incision made in the scrotal septum. It was assured that both the testes reached the hemiscrotum without undue tension. Follow-up with ultrasound at 6 months postsurgery showed both the testes properly placed in the scrotum with good consistency and vascularity. TTE was first reported by von Lenhossek in 1886.[2] The various theories to suggest the etiopathogenesis are-dysfunction of the genitofemoral nerve, true crossover of the testis, both the testis arising from the same genital ridge or both lying in the same processus vaginalis before descent. Management is orchidopexy, either transseptal or extraperitoneal transposition orchidopexy. A search for Mullerian remnants and other anomalies should be done.[3] Laparoscopy better delineates the anatomy and enables us to see the crossing over of the spermatic cord towards the opposite side. It helps assess the testis and its side, vas, and vessels for length. The management depends upon the length of the vas and vessels. If length is severely inadequate, both the testes are fixed in the same hemiscrotum and if the length is adequate, then transseptal orchidopexy is recommended. In cases, where there is inadequate or just adequate length, transseptal contralateral orchidopexy can be done.[4]
Figure 1
Intraoperative picture showing both the testis on the right side
Intraoperative picture showing both the testis on the right side
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Figure 1