Abdominal cryptorchidism with background complete dissociation between the testis and the deferent duct simulating testicular regression syndrome.

Abstract

Introduction. Complete separation of the deferent duct from the epididymis with the testicle in abdominal cryptorchidism cases is an extremely rare variation of abnormal development of genitals in boys. Available sources mention just 3 clinical cases similar to our observations. The unique anatomic details of the abnormality and extreme rarity of its exposure pave the way for a failure to reveal an intra-abdominal testis, and determine the need for particular attention during diagnostic laparoscopy. Materials and methods. Two patients with non-palpable left-sided cryptorchidism underwent a diagnostic laparoscopy, which revealed an intra-abdominal testis with epididymis on testicular vessels that was completely separated from the deferent duct. The difference between the described clinical cases was in the distance between the deep inguinal ring and the crossing of testicular vessels from the retroperitoneal location to the intraperitoneal position, which was approximately 3- 4 cm in the first patient and 4-5 mm in the second one. The second difference was in the "closed" deep inguinal ring found on the left side in the first case while the second patient had a patent processus vaginalis case. In both cases an incision was made in the left inguinal area, the inguinal canal was opened, and exploration thereof revealed blind-ended deferent ducts. The testicle in both cases was brought down through the inguinal canal and attached in the scrotum. Results. No complications occurred during the early postoperative care period, the check-up examination in 6 months following the surgery revealed no signs of testis atrophy or malposition in both patients. Conclusion. In diagnostic laparoscopy for abdominal cryptorchidism, it is important to consider the possibility of complete separation of the testicle and vas deferens. Detection of the deferent duct passing through the «closed» deep inguinal ring together with hypoplastic vessels does not rule out the chances for an ipsolateral intra-abdominal testis; therefore, a careful examination of the abdominal cavity along the embryological testicular migration path is necessary.