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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 19  |  Issue : 1  |  Page : 87-89

Cross testicular ectopia: A report of 4 cases


Department of Surgery, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Submission05-Mar-2021
Date of Decision09-Jun-2021
Date of Acceptance23-Feb-2022
Date of Web Publication12-Jul-2022

Correspondence Address:
Dr. Lawal Barau Abdullahi
Department of Surgery, Bayero University Kano/Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_35_20

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  Abstract 

Cross testicular ectopia is an extremely rare congenital anomaly affecting male children. It is a deviation of testicular descent resulting in unilateral location of both testes which poses a problem in diagnosis and treatment among clinician in the world. Over a period of 4years 4 cases of testicular ectopia were managed by our unit. All of our patients presented as outpatient. The record of their presentation, surgical management and the outcome of the treatment were studied and documented. The age ranges between 2 to 6years. All of the patients had trans septal orchidopexy as a day case surgery. Cross testicular ectopia is rare congenital urologic condition but the outcome of its management seem to be good, however long term follow up is required to evaluate the testicular function.

Keywords: Congenital, ectopia, testicular


How to cite this article:
Abdullahi LB, Mohammad MA, Anyanwu LJC. Cross testicular ectopia: A report of 4 cases. Niger J Basic Clin Sci 2022;19:87-9

How to cite this URL:
Abdullahi LB, Mohammad MA, Anyanwu LJC. Cross testicular ectopia: A report of 4 cases. Niger J Basic Clin Sci [serial online] 2022 [cited 2022 Oct 3];19:87-9. Available from: https://www.njbcs.net/text.asp?2022/19/1/87/350717


  Introduction Top


Crossed testicular ectopia, also known as transverse testicular ectopia, is an extremely rare congenital anomaly affecting one of the testes in boys.[1],[2] It is characterised by migration of one testis towards the opposite inguinal canal, usually associated with inguinal hernia.[3],[4] No much data on the incidence of the anomaly were available. The cause is not fully understood. The most common symptoms of testicular ectopia are ipsilateral inguinal swelling and absent testis; however, the accurate diagnosis is not usually made before surgery.[1],[3]

The common anomalies associated with this condition are persistent Müllerian duct syndrome, inguinal hernia, hypospadias, pseudohermaphroditism, and scrotal anomalies.[3],[4]

The treatment modalities include laparoscopic and open surgical procedures. There were two main options reported for orchidopexy: extra-peritoneal orchidopexy and trans-septal orchidopexy. In the extra-peritoneal technique, the testis is brought to the contralateral hemi-scrotum after its passage near the root of penis.[4],[5] In the trans-septal technique, the testis should traverse the scrotal mediastinum to be fixed in its hemi-scrotum.


  Case Reports Top


Case 1

AY is a 6-year-old patient who presented with a history of absent right testis since birth with a 2-year history of recurrent left groin swelling. On examination, he was found to be well preserved, afebrile, and not pale. Abdomen was full, moving with respiration, soft, and nontender. There is a soft, nontender left groin swelling which is reducible. The right hemi-scrotum was hypoplastic, with no palpable testis. An abdomino-pelvic ultrasound done could not demonstrate the right testis. An assessment of left inguinal hernia with right undescended testis was made. Parents were counselled and he was planned for left herniotomy and right orchidopexy. Intra-operatively, the right testicle was found within the left hernial sac with left testis fully descended in the left hemi-scrotum [Figure 1]. The patient had trans-septal orchidopexy by taking the right testis across the scrotal septum to the right scrotum and fixed within the sub-dertos space. The patient was discharged home some hours post-operatively after fully recovered from anaesthesia. He was followed up in the outpatient clinic for about 2 years.
Figure 1: Intra-operative picture of the first patient

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Case 2

BA is a 4-year-old patient who presented with a history of absent left testis since birth with a 6-month history of recurrent right groin swelling. On examination, he was found to be well preserved, afebrile, and not pale. Abdomen was full, moving with respiration, soft a nontender, with a soft, nontender right groin swelling which is reducible. The left hemi-scrotum was hypoplastic, with no palpable testis. An assessment of right inguinal hernia with left undescended testis was made. Parents were counselled and he was planned for right herniotomy and left orchidopexy. Intra-operatively, the left testicle was found within the right hernial sac with the right testis fully descended in the right hemi-scrotum [Figure 2]. The patient had trans-septal orchidopexy by taking the left testis across the scrotal septum to the left hemi-scrotum and fixed within the sub-dertos space. The patient was discharged home some hours post-operatively after fully recovered from anaesthesia. He was followed up in the outpatient clinic for about 1 year.
Figure 2: Intra-operative picture of the second patient

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Case 3

MS is a 3-year-old patient who presented to our paediatric surgery outpatient clinic with a history of absent right testis since birth with an 8-month history of recurrent left groin swelling. On examination, he was found to be well preserved, afebrile, and not pale. Abdomen was full, moving with respiration, soft nontender, with a soft, nontender left groin swelling which is reducible. The right hemi-scrotum was hypoplastic, with no palpable testis. An abdominal and groin ultrasound done could not demonstrate the right testis. An assessment of left inguinal hernia with right undescended testis was made. Parents were counselled and he was planned for left herniotomy and right orchidopexy. Intra-operatively, the right testicle was found within the left hernial sac with left testis fully descended in the left hemi-scrotum [Figure 3]. The patient had trans-septal orchidopexy by taking the right testis across the scrotal septum to the right scrotum and fixed within the sub-dertos space. The patient was discharged home some hours post-operatively after fully recovered from anaesthesia. He was followed up in the outpatient clinic for about 10 months.
Figure 3: Intra-operative picture of the third patient

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Case 4

RB is a 2½-year-old patient who presented to our clinic with history of absent right testis since birth with a 6-month history of recurrent left groin swelling, with no history of abdominal pain or abdominal distension. On examination, he was found to be well preserved, afebrile, and not pale. Abdomen was full, moving with respiration, soft and nontender, with a soft, nontender left groin swelling which is reducible. The right hemi-scrotum was hypoplastic, with no palpable testis. An abdomino-pelvic ultrasound done could not demonstrate the right testis. An assessment of left inguinal hernia with right undescended testis was made. Parents were counselled, and he was planned for left herniotomy and right orchidopexy. Intra-operatively, the right testicle was found within the left hernial sac with left testis fully descended in the left hemi-scrotum. The patient had trans-septal orchidopexy by taking the right testis across the scrotal septum to the right scrotum and fixed within the sub-dertos space. The patient was discharged home some hours' post-operatively. He did well and was follow-up in the clinic up to 6 months.


  Discussion Top


As shown in [Table 1], between February 2014 and January 2018, four boys with cross testicular extrophy were managed in our unit. All of them presented as elective cases in our outpatient clinic. The symptoms at presentation were absent right testis and left groin swelling in three patients, while one of them had absent left testis and right groin swelling. The age at presentation ranges between 2 and 6 years, which similar to most of other studies.[1],[4],[5] At presentation in the clinic, three of the patients had abdomino-pelvic ultrasound. None of the patients was diagnosed with ectopia before the surgery; the diagnosis was made intra-operatively. This is similar to other studies that reported testicular ectopia to be mainly intra-operative diagnosis.[2],[4],[6],[7],[8],[9] No any other associated congenital anomaly was identified in our patients except the associated contralateral inguinal hernia; this may due to inadequate evaluation because of financial problem from the patient and lack of available tool for evaluation such as paediatric laparoscopy and magnetic resonance imaging. All of the patients had trans-septal orchidopexy. The outcome of the procedure seems to be good; only one of our patients developed surgical site infection. All of the patients were followed up for minimum of 6 months though one of the patients lost to follow-up after 6 months; however, a long follow-up is required to evaluate the fertility function of the testis and to detect possible testicular tumour which is reported to be common among the patient testicular ectopia.[10]
Table 1: Cases summary

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  Conclusion Top


Cross testicular ectopia is rare congenital urologic condition, but the outcome of its management seem to be good; however, long-term follow-up is required to evaluate the testicular function.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Salah SE, Elhaj KI, Awadelseed YO, Mohammed SG. Crossed testicular ectopia a case report and review of the literature. Ann Pediatr Surg 2016;12:170-2.  Back to cited text no. 1
    
2.
Feizzadeh KB, Mohamadzadeh RM. Crossed testicular ectopia: A case report. Urol J 2005;2:222-3.  Back to cited text no. 2
    
3.
Vaos G, Zavras N. Irreducible inguinal hernia due to crossed testicular ectopia in an infant. Hernia 2004;8:397-8.  Back to cited text no. 3
    
4.
Abdelmohsena SM, Osmanb MA, Takrouneyb MH, Abdelazimc O, Fathyd M, Mostaf HA, et al. Crossed testicular ectopi. J Pediatr Surg Case Rep 2018;37:50-6.  Back to cited text no. 4
    
5.
Avolio L, Belville C, Bragheri R. Persistent Müllerian duct syndrome with crossed testicular ectopia. Urology 2003;62:350.  Back to cited text no. 5
    
6.
Hughes DT, Croitoru DP. Case report: Crossed testicular ectopia. J Pediatr Surg 2007;42:1620-2.  Back to cited text no. 6
    
7.
Ben Dhaou M, Louati H, Kotti A, Zitouni H, Jalouli M, Mhiri R. Diagnosis and treatment of crossed testicular ectopia. Iran J Public Health 2016;45:1232-3.  Back to cited text no. 7
    
8.
Akin M, Erginel B, Bilici S, Gedik S, Yıldız A, Karadağ CA, et al. Crossed testicular ectopia: Report of six cases. Afr J Paediatr Surg 2014;11:269-72.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Muhammad UN, Abba K, Chaudhr MA. Crossed testicular ectopia: A very rare congenital anomaly. EC Paediatr 2018;7:73-6.  Back to cited text no. 9
    
10.
Raj V, Redkar R, Krishna S, Tewari S. Rare case of transverse testicular ectopia – Case report and review of literature. Int J Surg Case Rep 2017;41:407-10.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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