We recently encountered a seven-year-old boy having type I transverse testicular ectopia (TTE). He presented with left inguinal hernia and contralateral impalpable undescended testis; the left testis was normally located in the ipsilateral hemiscrotum. During left herniotomy, a second testis was unexpectedly delivered through the deep inguinal ring. The two testes shared the common patent processus vaginalis. The two vasa deferentia were fused for a short length about 4 cm. above the testes. The vascular supply to the ectopic testis originated from the appropriate ipsilateral side. Presence of mullerian ductal structures was ruled out by laparoscopy; optical camera could be easily introduced through the open hernial sac. Because of the ductal fusion, the ectopic testis was brought down on the left side to avoid damage during separation and placed in either hemiscrotum through transceptal window.

TTE, also named testicular pseudo-duplication, unilateral double testis and transverse aberrant testicular maldescent, is an uncommon anatomical abnormality in which both the gonads migrate towards the same hemiscrotum; only about hundred cases have been reported in literature. The ectopic testis may lie in opposite hemiscrotum, in the inguinal canal or at the deep inguinal ring. An inguinal hernia is invariably present on the side to which the ectopic testis is migrated. Variations in the anatomical position of the vasa deferentia and abnormalities of insertion of the vas into the testis can occur. Fusion of vasa deferentia has been described previously also(1).

Based on the presence of various associated anomalies, TTE has been classified into 3 types: (i) associated with inguinal hernia alone (40-50%); (ii) associated with persistent or rudimentary mullerian duct structures (30%); (iii) associated with other anomalies without mullerian remnants (inguinal hernia, hypospadias, pseudo-hermaphroditism and scrotal abnormalities) (20%)(2).

The mean age at presentation is 4 years(2). In most of the cases, the correct diagnosis was not made pre-operatively and the condition was revealed during herniotomy. Recently, MRI and MR venography have been suggested for preoperative location of impalpable testis(3). Laparoscopy is useful for both diagnosis and management of TTE and the associated anomalies(4). Treatment includes transceptal orchidopexy or extra-peritoneal transposition of the testis, search for mullerian remnants and other anomalies and long-term postoperative follow-up. Like all dysgenetic testes, infertility and progression to malignancy are relatively frequent with TTE(5).

We emphasize that associated mullerian ductal structures, if any, should be ruled out by laparoscopy or mini-laparotomy in the same sitting.

Y.K. Sarin,
N.G. Nagdeve,
Department of Pediatric Surgery,
Maulana Azad Medical College,
New Delhi 110 002, India.

1. Barrack S. Crossed testicular ectopia with fused bilateral duplication of the vasa deferential: an unusual finding in cryptorchidism. East Afr Med J 1994; 71: 398-400.

2. Gauderer MW, Grisoni ER, Stellato TA, Ponsky JL, Izant RJ Jr. Transverse testicular ectopia. J Pediatr Surg 1982, 17: 43-47.

3. Lam WW, Le SD, Chan KL, Chan FL, Tam PK. Transverse testicular ectopia detected by MR imaging and MR angiography. Pediatr Radiol 2002; 32: 126-129.

4. Gornall FG, Pender DJ. Crossed testicular ectopia detected by laparoscopy. Brit J Urol 1987; 59: 283.

5. Fujita J. Transverse testicular ectopia. Urology 1980; 16: 400-402.