A rare case of duplicated vas deferens discovered accidentally during varicocelectomy

Multiple vas deferens with polyorchidism and many congenital malformations in a symptomatic 11-year-old male patient: a rare case report

Background

Ductus deferens may manifest in a variety of anomalies such as its absence, duplication, ectopy, or diverticulum. Ectopic seminal tract opening has two main types, ectopic ejaculatory duct opening, and ectopic vas deferens opening. Generally, ductus deferens anomalies affect approximately 0.05% of the population. Patients may be asymptomatic or complaining of urinary tract infections and/or epididymitis. Most of these cases are associated with renal dysplasia. To confirm the diagnosis Cystourethroscopy catheterization and retrograde urethrogram should be performed, but the definitive diagnosis is done by vasography. The definitive treatment is complete surgical resection of the pathological urogenital connection. This case is commonly discovered while exploring other findings such as testicular torsion and inguinal hernia.

Case presentation

We report a rare case of an 11-year-old male who presented with gross hematuria and numerous congenital malformations including a left polydactyly clubfoot, polyorchidism, with several surgical procedures, and left kidney dysgenesis. Surgery was performed for a left inguinal hernia, during which a third undescended testicle was discovered incidentally and was eradicated. A retrograde urethrogram was performed to establish the diagnosis. A fistula- that is connected with the left ureter- was resected. The histopathologic findings confirmed the diagnosis of true duplication of the Vas deferens, with communication between the ureter and the vas deferens. By follow-up, the kidney function tests were within normal limits.

Conclusions

This case report aims to highlight the early diagnosis and management of the duplicated vas deferens and the associated congenital malformations to improve the prognosis and kidney function and to avoid long-term complications.

Duplicated vas deferens: A case report and comprehensive review of the literature

Duplication of vas deferens is a very rare anomaly which two vasa deferentia are found in the spermatic cord. It can be recognised during autopsy or cadaveric dissection and also several surgical procedures which require spermatic cord dissection including inguinal hernia repair, orchiopexy, vasectomy, varicocelectomy, vasectomy reversal and radical prostatectomy. Recognition of the duplicated vas deferens is important to avoid surgical complications such as an unsuccessful vasectomy or transection of the vas. It was reported in only three cadavers and 31 patients since 1959. In this study, we describe a new case of duplicated vas deferens found incidentally during routine inguinal hernia repair in a 66-year-old patient. We also review all previously reported cases in the literature to draw attention to this rare but important anomaly.

Duplicated vas deferens as an incidental finding during indirect inguinal hernia repair: A case report and literature review

Duplication of vas deferens is an anomaly that is generally encountered during inguinal hernia repair, orchiopexy, radical prostatectomy, varicocelectomy, and vasectomy. The estimated rate of this anomaly in the United States is 0.01%. This anomaly may predispose to iatrogenic vas deferens injury during inguinal hernia repair. Embryological point of view suggests that the duplication of the mesonephric duct system could result in duplicated vas deferens. Failure to recognize this anomaly may lead to injury, obstruction, or spermatic granuloma. Furthermore, it is important to identify duplicated vas deferens during vasectomy to avoid failure of the procedure. Identification of duplicated vas deferens is important during inguinal hernia surgery, vasectomy, and varicocelectomy. Herein, we report a case of duplicated vas deferens during open indirect inguinal hernia repair.

Duplicate vas deferens in a 3-year-old boy: a case report and review of paediatric literature

Background

Congenital abnormalities of the vas deferens are very uncommon. Duplicate vas deferens is a rare abnormality. It is the presence of two separate vasa deferentia within one spermatic cord. It has been encountered during inguinal hernia repair, orchidopexy, varicocoelectomy, vasectomy and radical prostatectomy. Identification of the vas deferens is mandatory during surgeries involving manipulation of the spermatic cord because if duplication exists and is not detected, there is increased chance of iatrogenic injury.

Case presentation

We present a 3-year-old boy with duplicate vas deferens identified during herniotomy for a right hydrocele. A postoperative abdominopelvic ultrasound scan revealed no abnormalities.

Conclusion

The risk of iatrogenic injury to the vas is increased in the presence of a duplication. A deliberate identification of the vas during procedures involving manipulation of the spermatic cord reduces this risk.