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July 1995, Volume 45, Issue 7

Case Reports

Transverse Ectopia of the Testis : A Case Report

Tanwir Khaliq  ( Department of General Surgery, Quaid.e-Azam Postgraduate Medical College, Pakistan Institute of Medical Sciences, Islamabad. )
Rakhshanda Rashid  ( Department of General Surgery, Quaid.e-Azam Postgraduate Medical College, Pakistan Institute of Medical Sciences, Islamabad. )
Zafar Iqbal Malik  ( Department of General Surgery, Quaid.e-Azam Postgraduate Medical College, Pakistan Institute of Medical Sciences, Islamabad. )

Abstract

A case of transverse ectopia of the testis in a man of 30 years is presented. The patient was admitted for a right inguinal herniorraphy and the finding of ectopic testis was accidental.

Introduction

Anectopic testis is defined as the testis which has shifted away from its nonnal pathway of migration between the abdominal cavity and the bottom of the scrotum and is located in an ectopic position. The five major sites oftesticularectopia are the superficial inguinal pouch, the perineum, the femoral canal, the suprapubic area and the opposite scrotal compart­ment (transverse). The transverse testicular ectopia is the rarest of all ectopic positions, also called paradoxical descent or transverse aberrant testicular maldescent and it is the conditionwherebothtestes descend throughthe same inguinal canal to the same side of scrotal sac, or the testis which has crossed over may be trapped ma hernial sac. On reviewing the literature 85 cases have been reported so far1,2.

Case Report

A 30 years old man, married and father of a child, presented in the surgical outpatient of PIMS with a right inguinoscrotal swelling that was present since birth, but had recently increased in site and was painful off and on. A diagnosis of right inguinal hernia was made. It was reducible and indirect. The scrotum looked normal but a thick cord was palpable at the root of right side of scrotum. After routine investigations, he was put on waiting list for hemiorrhaphy (six weeks later at an elective list). Exploration of right groin revealed a large sac. There were two thick cords emerging from the deep ring with the sac 2lying in between. Because of difficult dissection, the scrotal contents were delivered out and sac was opened. Both the testes were lying in the sac and their gross appearance was normal. The right testis was placed well in the scrotum whereas the left ectopic testis was lying at the’ root of scrotum. The dissection also revealed two vasa defrentiaandavas like stmcturejoimng the two testes. The sac was dissected from the cords and transfixed at the deep ring. Both testes were replaced in the scrotum: one of them was fixed to the septum and the other to the floor of the scrotum. Routine herniorrhaphy was performed. The patient made a smooth, uneventful recovery and was discharged a week later. A post-operative ultrasound revealed no genitourinary abnor­mality and confirmed the position of both the testes inthe right hemiscrotum.

Discussion

Lenhossak published the earliest report about transverse ectopia of the testis. Haistead described whatwas probably the first recorded case in the English literature. Since then, about 85 cases have been reported in literature todate1. Testicular ectopia is believed to be directly related to the development of the gubernaculum, which is known to be divided in to five slips, one going to each of the ectopic sites. The scrotum normally contains the bulk of gubernaculum and the testis normally follows this path during its descent. It has been suggested that when one of the other four branches contains the bulk of the gubernaculum, thetestis is misdirected from its normal pathways of descent into the eetopic loca­tion3,4. The concept of third testis was given by Campbell5, according to which transverse ectopia is in fact a unilateral development of two testes: the contralateral testis also develops but is retained inthe abdomen. Therefore, he stressed foralaparatomy to lookforthe third testis, because ofhighrisk of malignancy in it. The most common ectopic location is the superficial inguinal pouch lined by thin fibrous tissue, lateral to the external inguinal ring. The transverse testicular ectopia is the rarest of all types but probably has got the same mechanisms of its aberrant descent. Clinically, the most common mode of presentation is inguinoscrotal swelling: congenital inguinal hernia is the most frequent associated anomaly, but rarely there can be hypo­spadias and a small, infantile uterus within the scrotal sac. In the recorded cases, the right testis was usually the ectopic one and rarely the left testis had gone over to the right side (as in our case). If one detects an empty hemiscrotum on clinical examination and an additional mass is felt in the contralatemi scrotum, transverse testicular ectopia should be considered. Anabdominal ultrasound should be earned out to discover any associated genitourinary anomaly, which was done inourcase post-operatively. Surgical intervention is required either to replace the testis in the scrotum, if possible, or to remove the testis if it is atrophic. The associated hernia should be repaired. The risk of malignancy and torsion is highinanectopic testis. Inone of the cases reported, a malignant tumour was diagnosed.

Acknowledgements

The authors are indebted to Jack W. McAninch, Profes­sor of Urology, University of Califomia, San Francisco, for encouraging the report of this ease and his valuable comments.

References

1. McAninch, J. W. Disorders of the testis, scrotum and spermatic cord. In (eds) Tanagho, E. A., McAninch, J.W. Smith’s General Urology 12th edn., Appleton andLange, 1988, p. 617.
2. Dajani, A. M. Transverse ectopia of the testis. Br. J. Urol., 1969;4:80-82.
3. Rajfer, J. Technique oforchiopexy. Urn!. Clin. North Am., 1982; 9 (3):422.
4. Rajfer; J. Congenital anomalies of the testes. In (ads) Patrick CW eta!: Campbell’s Urology 6th ed., Vol 2, Philadelphia, W.B. Saunders and Co., 1992, p. 1548.
5. Campbell, M. F. Principles of Urology. Philadelphia, WB Saunders and Co., 1957, p. 1999.

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