WOFAPS 2025 8th World Congress of Pediatric Surgery

Anum Liaquat, Syeda Rawash Mehdi, Syed Faisal Usman

Indus Hospital - Recep Tayyip Erdogan Campus, Muzaffargarh

Introduction:Crossed testicular ectopia (CTE) is a rare congenital anomaly where one testis is located into the opposing abdominal cavity,inguinal canal,or even descend into the opposing hemi-scrotum. It has been classified into three types: Type 1:-associated with inguinal hernia alone . Type 2:-associated with persistent or rudimentary müllerian duct structures . Type 3 :-associated with other anomalies without mullerian remnants (inguinal hernia, hypospadias, pseudohermaphroditism, and scrotal abnormmullerian, other Associated anomalies of vas deferens are very rare which include fusion defects, supernumerary vas,discontinuity of vas and agenesis of vas.

Case Presentation:We present a rare case series of crossed testicular ectopia Type 2 in 2-year-old twin brothers and their 1 year- old younger sibling with Type 1 along with vas abnormality.
The 2-year old twin brothers presented with a history of bilateral undescended testes.Physical examination revealed underdeveloped empty scrotum and non palpable testes in the line of descent or any ectopic sites. On Ultrasound, only right testes was visulaized above deep ring .Diagnostic laproscopy was performed which showed , right testes above the right deep ring and left testes also on the right side above the right testes. Two separate vas were identified associated with persistent mullerian duct stuctures including rudimentary uterus and left fallopian tube. Due to heterogeneous structures , procedure was concluded and karyotyping was done , which was XY and bilateral orchidopexy and excision of mullerian duct was planned.
Their 1-year old brother presented with right undescended testes and left sided inguinal hernia. On examination, both testes were palpable in left hemiscrotum.During herniotomy and bilateral orchidopexy, continuity of both vas deferens near preperitoneal fat was doubtful, for which diagnostic laproscopy was planned later in addition for diagnosis of mullerian duct remnants. On diagnostic laproscopy, testicular arteries were identified but both vas and mullerian duct remanats were not found.

Conclusion:
CTE is an extremely uncommon anomaly with no confirmed cause. Multiple related anomalies are evident as mullerian duct remnant, vas anomalies, scrotal problems and hypospadias .Laparoscopy is useful for both evaluation and management of CTE and associated anomalies. Treatment involves surgically relocating CTE to the orthotopic position. When it is Type 2 CTE, this may involve excision of mullerian remnants or leaving behind a cuff of mullerian remnants still attached to the testis or the main bulk of mullerian structure may be left in situ to preserve testicular blood supply. Patients frequently require long-term follow-up since they may have future problems with fertility and are at a greater risk of developing testicular malignancy.