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Sattout H, Jabra M, Malahefji H, Morjan M. Transverse testicular ectopia with an inguinal hernia: A rare case report. Int J Surg Case Rep 2024; 121:109949. [PMID: 38943934 PMCID: PMC11261408 DOI: 10.1016/j.ijscr.2024.109949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Transverse testicular ectopia (TTE) is a rare congenital condition characterized by migration of both testes through the same inguinal canal and often presents with an inguinal hernia. TTE is associated with various genitourinary anomalies. CASE PRESENTATION A three-year-old boy presented with a non-palpable right testis and a palpable undescended left testis in the left inguinal area. Ultrasound (US) indicated the presence of both testes in the left inguinal canal. In surgery, the two testes were found with separated cord and one hernia sac which was dissected and ligated thus the two cords freed. Next, subdartos pouches were created on both scrotum sides, so that testes placed into the left side first, and then a window created in the scrotal septum which allowed the right testis to be translocated and secured in the right subdartos pouch without tension. DISCUSSION TTE is a rare condition and the etiology is not definitively known. TTE usually presents with an inguinal hernia and contralateral cryptorchidism. The diagnosis is made during surgery, but some radiological methods can help in diagnosis. Management is usually surgical and involves interventions such as hernia repair, reduction of the testis and orchiopexy. Continuous monitoring is essential for ensuring postoperative testes health and evaluating the risk of malignancy. CONCLUSION TTE should be suspected in cases with unilateral empty scrotum and family history of genital disorders. US is critical for accurately localizing the testes, along with surgical exploration, to proceed with the appropriate surgical intervention.
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Affiliation(s)
- Hanin Sattout
- Department of Endocrinology, Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Maya Jabra
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Hiba Malahefji
- Department of Pediatric Surgery, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Mohamad Morjan
- Department of Pediatric Surgery, Faculty of Medicine, University of Aleppo, Aleppo, Syria.
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Chen J, Guo MF, Li H, Han N, Hu CB, Sun JS, Zhang CF, Su L. Testicular ectopia: A case report. Exp Ther Med 2023; 26:348. [PMID: 37383372 PMCID: PMC10294606 DOI: 10.3892/etm.2023.12047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/31/2023] [Indexed: 06/30/2023] Open
Abstract
This paper mainly describes three cases of children with ectopic testis, of which two patients with transverse testicular ectopia (TTE) and one with perineal ectopic testis (PET). All patients who underwent orchidopexy at the same pediatric surgical unit in the Affiliated Hospital of Jining Medical University (Jining, China) between June 2010 and February 2021 were retrospectively evaluated (age range, 14-34 months). A total of two patients (67%) was admitted with asymptomatic unilateral inguinal masses and the contralateral testis missing; the first patient was diagnosed with TTE intraoperatively, whereas the other patient was diagnosed with TTE through physical examination and ultrasound preoperatively. The third patient (33%) was admitted with the right testis missing and a left perineal mass, which was confirmed using PET by physical and ultrasound examination before the operation. The first two patients underwent transseptal orchidopexy, whereas the third patient underwent simple orchidopexy. Postoperative complications were not observed (follow-up, 10-24 months). The low incidence and poor understanding of ectopic testis compels us to report our findings and further discuss this particular disease of testicular ectopia, including its pathogenesis, diagnostic and treatment options.
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Affiliation(s)
- Jie Chen
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong 272013, P.R. China
| | - Meng-Fu Guo
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong 272013, P.R. China
| | - Hui Li
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong 272013, P.R. China
| | - Nuan Han
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Chuan-Bing Hu
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Jin-Song Sun
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Chong-Fang Zhang
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Lin Su
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
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Yang M, Lin X, Liu Z, Zhang P, Xiao W, Chen Y, Chen Y, Zhuang Y, Zheng L, Duan S. Transverse testicular ectopia with persistent Mullerian duct syndrome: Report and review of two cases. Andrologia 2022; 54:e14637. [PMID: 36357339 DOI: 10.1111/and.14637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022] Open
Abstract
Transverse testicular ectopia is a rare anomaly characterized by both testes descending through a single inguinal canal. The objective of this study was to investigate the pathogenesis, diagnosis, and treatment of transverse testicular ectopia (TTE) with persistent Mullerian duct syndrome (PMDS), and to deepen the understanding of the disease in clinical. A retrospective analysis of the clinical manifestation, diagnosis, and treatment of two children suffering from TTE with PMDS was conducted. Previous studies on the characteristics, diagnosis, and treatment of this disease were reviewed. The two patients were treated with laparoscopy-assisted transseptal orchidopexy-inguinal evaluation. After the surgery, the two patients recovered well. The follow-up visits were done 3 months after the operation. An ultrasound examination confirmed that the two patients had testes in the orthotopic position and normal size. TTE with PMDS is an exceedingly rare disease. The patients manifested cryptorchidism on one side; contralateral inguinal hernia was suspected. Detailed physical and ultrasound examinations before the operation are the key to the early diagnosis of TTE. Laparoscopic evaluation is helpful for the diagnosis and finding of other abnormalities. Surgical treatment is the only method to cure the disease; long-term follow-up is needed after TTE operation.
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Affiliation(s)
- Min Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaobin Lin
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhijun Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Peijian Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Wang Xiao
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yingchun Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yiyi Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yangmu Zhuang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Lian Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shouxing Duan
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Department of Pediatric Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
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Dirie NI, Garba B, Nur MAS, Dirie AI, Albalulah RA. Transverse testicular ectopia with persistent mullerian duct syndrome: Misdiagnosis and surgeon's unexpected discovery: A case report. Urol Case Rep 2022; 44:102164. [PMID: 35873896 PMCID: PMC9305355 DOI: 10.1016/j.eucr.2022.102164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/30/2022] Open
Abstract
Reports on the occurrence of persistent mullerian duct syndrome along with transverse testicular ectopia are extremely rare globally. In this condition, the fallopian tubes, uterus, cervix and upper two-thirds of vagina occurs alongside transverse testicular ectopia. In most cases, the condition is discovered as an incidental finding during surgical procedures. In this report, we present a case of a 29-year-old Somali male that had scrotal swelling, pain around the inguinal area and perceived infertility for over seven years whom we incidentally found to have a persistent mullerian duct syndrome with transverse testicular ectopia and managed accordingly.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Dr. Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
- Corresponding author.
| | - Bashiru Garba
- Institute for Medical Research, SIMAD University, Mogadishu, Somalia
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Usmanu Danfodiyo University Sokoto, Nigeria
| | - Maryan Abdullahi Sh. Nur
- Department of Obstetrics and Gynecology, Dr. Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Abdulkadir Isse Dirie
- Department of General Surgery & Laparoscopy, Mogadishu City Hospital, Mogadishu, Somalia
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Persistent Müllerian Duct Syndrome: Understanding the Challenges. Case Rep Urol 2022; 2022:2643833. [PMID: 35386545 PMCID: PMC8977345 DOI: 10.1155/2022/2643833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Persistent Müllerian duct syndrome (PMDS) is a rare autosomal recessive condition defined by the presence of Müllerian duct-derived structures in an otherwise normally masculinized phenotypical and genotypical (46,XY) male. We describe the case of an infant diagnosed with PMDS, managed and followed up for 7 years. The diagnosis of PMDS was made at laparoscopy at 6 months of age for investigation and management of bilateral impalpable testes. A Müllerian structure resembling a uterus with bilateral fallopian tube-like structures was seen in the pelvis, along with bilateral intra-abdominal testes. Gonadal biopsy confirmed normal testicular tissue. The child underwent successful bilateral two-stage Fowler-Stephens orchidopexies. The Müllerian remnant was preserved to maintain testicular vascularity. At the most recent follow-up, the testes are intrascrotal and normal on palpation. There have been no clinical symptoms or concerns with the Müllerian remnant during surveillance with ultrasound and MRI. To date, there are less than 300 cases described in the medical literature, with limited consensus on management. We reflect on challenges the condition poses, including fertility preservation in PMDS, testicular and Müllerian malignancy risk in PMDS, and optimal management and surveillance of PMDS.
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Zhou W, Li S, Wang H, Yin J, Liu X, Jiang J, Zhou G, Wen J. Diagnostic value of ultrasound in children with transverse testicular ectopia. Front Pediatr 2022; 10:914139. [PMID: 36061385 PMCID: PMC9433715 DOI: 10.3389/fped.2022.914139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study aimed to investigate the diagnostic value of ultrasound in children's transverse testicular ectopia (TTE). MATERIALS AND METHODS We retrospectively studies all TTE cases diagnosed in our hospital from January 2017 to December 2021. All cases were evaluated by ultrasound examination and compared to physical examination and diagnostic laparoscopy results. RESULTS This study included 14 TTE patients in total, with a median age was 1.08 years. In the 14 TTE, physical examination found 10 TTE cases, of which nine testes were located in the opposite scrotum, one testis was located in the opposite groin, and the other four testes were not observed by physical examination. All cases were diagnosed by preoperative ultrasound, and nine testes were located in the opposite scrotum, two testes were located in the opposite groin, and three testes were located next to the opposite iliac vessel in the abdominal cavity. Preoperative ultrasound showed the ectopic spermatic cord in six cases (6/14, 42.8%) and persistent Müllerian duct syndrome (PMDS) in one case (1/14, 7%). Diagnostic laparoscopy finally confirmed 14 cases of TTE, which was consistent with preoperative ultrasound, and the coincidence rate was 100% (14/14). Among the 14 cases of TTE, diagnostic laparoscopy showed that 12 cases had ectopic spermatic vessels and vas deferens (12/14, 85.7%), and six cases were associated with PMDS (6/14, 42.8%). When TTE was associated with the ectopic spermatic cord and PMDS, the diagnostic performance of diagnostic laparoscopy was better than that of preoperative ultrasound (P < 0.05). The testis volume of the affected side of TTE was less than that of the contralateral testis (P < 0.05). CONCLUSION Ultrasonography is very helpful for the preoperative diagnosis of TTE in children, and it is suitable as a non-surgical method for locating ectopictestis. Preoperative assessment of the exact presence of PMDS is difficult and unclear. This may be related to factors such as pelvic developmental stages in infancy, examination techniques, and atypical imaging findings of PMDS.
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Affiliation(s)
- Wei Zhou
- Pediatric Urodynamic Centre, Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Hao Wang
- Pediatric Urodynamic Centre, Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianchun Yin
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaodong Liu
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Junhai Jiang
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianguo Wen
- Pediatric Urodynamic Centre, Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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