An unusual case of testicular ectopia

Pediatr Surg Int (1996) 11:281-282

© Springer-Verlag 1996

E. Giinel • A. H. G i i n d o ~ a n

An unusual case of testicular ectopia

Accepted: 14 August 1995 A b s t r a c t A testis is termed ectopic when it lies outside the normal line of descent. A case of testicular ectopia in which the testicle was located cranial and lateral to the internal ring dorsal to the external oblique muscle is reported in a 2-month-old boy. This highly aberrant ectopic testis was treated succesfully by orchiopexy; as far as we know, this is the second such case in the literature. K e y words

ectopia, i.e., a testis lying outside the normal line of descent and excluding those in the superficial inguinal pouch, is rare. Five variants of true ectopia are known: perineal, transverse, pubopenile, femoral, and preperitoneal [6]. We report a case of testicular ectopia involving an ectopic testicle located cranial and lateral to the internal ring between the external and internal oblique musculature. This condition has been reported only once before.

Ectopic testis •

Fig. 1 Photograph showing mass in right lower abdomen

Orchiopexy

Case report Introduction The ectopic testis is a relatively rare entity that is easily recognized and treated by orchiopexy [5]. It has been reported that 5% of maldescended testes are ectopic [3]. Approximately 80% of the reported cases of ectopic testes were unilateral, usually normal in size, with normal spermatogenic and androgenic function [2]. Ectopic testes emerge outside the external inguinal ring and then are misdirected along the course of their remaining descent to arrive at an abnormal position [5]. True testicular

A 2-month-old boy was referred to our clinic for differential diagnosis and treatment of a mass located on the right lower abdomen. The right hemiscrotum was empty and there was no evidence of a palpable testicle in the right inguinal region. The left testis was palpable in the scrotum (Fig. 1). On exploration, it was found that the mass was an indirect inguinal hernia. The internal and external rings were larger than. normal size. The patent processus vaginalis (hernia sac) accompanied the cord structures in a lateral and cranial direction between the internal and external oblique musculature. The testicle was normal in size and located 7 cm lateral and cranial to the internal ring. The hernia was repaired by high ligation. The external ring was narrowed, and orchiopexy was performed easily because the length of the cord structures was adequate for placement of the testicle into the scrotum.

E. Grind • A. H. Gtindo~an Department of Pediatric Surgery, Sel~uk University Faculty of Medicine, Konya, Turkey

Discussion

E. Grind (ES~) Babahk mah. Vatan cad. Kartal Sitesi No: 12/5, TR-42040 Konya, Turkey

The etiology of testicular ectopia is uncertain. Traditionally the concept proposed by Lockwood has been

used to explain its origin [7]. He reported that the gubernaculum testis terminates in five tails that are attached to: (1) the bottom of the scrotum; (2) the front of the pubis; (3) the perineum; (4) Scarpa's triangle in the thigh; and (5) the region of the inguinal ligament just medial to the anterior superior iliac spine. Lockwood [4] postulated that the guberuacular tail passing to the scrotum was normally the stronger one and pulled the testis into the scrotum. If one of the other tails gained a mechanical advantage, the testis was pulled into an ectopic position. The embryology of testicular descent and maldescent has been reviewed extensively by Backhouse [1]. He believes ectopia occurs not due to pulling by the gubemaculum, but by encroachment by the developing body wall fascia into the simple mesenchyme of the gubernaculum, which forces the testicle to move in other

282 directions, taking the pathway of least resistance between fascial layers. We could find only one report of testicular ectopia in which the testicle was located cranial and lateral to the internal ring dorsal to the external oblique muscle. There is no definite explanation for this highly aberrant type. Regardless of the location, in this case an orchiopexy could be done succesfully because the spermatic cord was sufficiently long.

References 4. 1. Backhouse KM (1982) Embryology of testicular descent and maldescent. Urol Clin North Am 9:315-320 2. Fonkalsrud EW (1986) Undescended testes. In: Welch RJ, Randolph JG, Ravitch MM, O'Neil JA, Rowe MI (eds) Pediatric surgery. Year Book Medical Publishers, Chicago, pp 793-807 3. George FW, Wilson JD (1986) Embryology of genital tract. In: Walsh PC, Gittes RF, Perlmutter AD, Stamey TA

5. 6. 7.

(eds) Campbell's urology, 5th edn. Saunders, Philadelphia, pp 1804-1818 Lockwood CB (1888) Development and transition of testis, normal and abnormal. J Anat 22:505-541 Middleton GW, Beamon CR, Gillenwater JY (1976) Two rare cases of ectopic testis. J Urol 115:455-458 Murphy DM, Butler MR (1985) Preperitoheal ectopic testis: a case report. J Pediatr Surg 20:93-94 Redman JE Brizzolara JP (1985) An unusual case of testicular ectopia. J Urol 133: 104-104