Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Salman Atiq Siddiqui, Tamer Ibrahim Marei, Ghada Al-Makhaita
(Department of Medical Imaging, Imam Abdul Rahman Bin Faisal Hospital, National Guard Health Affairs, Dammam, Saudi Arabia, affiliated with King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh, Saudi Arabia)
Am J Case Rep 2016; 17:490-493
Abnormal testicular descent can either be undescended or, less commonly, ectopic. Most undescended testes complete the course of descent by the first year of life only if these remain in the normal path of descent. The deviation of the testis may occur to an ectopic location during the transinguinal phase. Of the known ectopic sites, the anterior abdominal wall is the rarest site of testicular ectopia and to our knowledge only 3 cases of this nature have been reported in the available literature to date.
CASE REPORT: This rare case of testicular ectopia occurred in a 3-day-old boy in whom the right scrotal sac was empty; on abdominal ultrasound, the right testis was found in the subcutaneous tissues of the right antero-lateral abdominal wall. These findings were confirmed on abdominal MRI, where the right testis was seen beneath the skin between the subcutaneous tissues and external oblique aponeurosis. No aponeurotic or muscular defect was appreciable under the abdominal wall. The neonate underwent orchiopexy at the age of 6 months and remained uneventful postoperatively.
CONCLUSIONS: Preoperative imaging is recommended to detect and confirm the ectopic site as well as the morphology of testis, thereby increasing the chance of surveillance and preservation of an ectopic testis. Imaging can serve as preoperative road mapping to localize the exact site for surgical exploration of an ectopic testis if there is no apparent or palpable swelling over the anterior abdominal wall.
Keywords: Cryptorchidism - surgery, Abdominal Wall - surgery, Humans, Infant, Newborn, Magnetic Resonance Imaging, Male, Orchiopexy - methods, Testis - abnormalities, Treatment Outcome, Ultrasonography