Case reportMissed testis on laparoscopy despite blind-ending vessels and closed processus vaginalis
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Case report
A 1-year-old boy with a left nonpalpable testis and an ipsilateral multicystic dysplastic pelvic kidney had a negative examination under anesthesia and scrotal exploration. Laparoscopy revealed a large left multicystic kidney. A closed internal ring, no evidence of a vas deferens, and distinct vessels ending blindly were noted (Fig. 1). These vessels originated from a cephalad source and traveled over the psoas muscle.
One year later, the kidney had grown by ultrasound measurement. Therefore,
Comment
This case reiterates the importance of a thorough examination during exploration of a nonpalpable testis. In this case, we missed the testis on both scrotal and laparoscopic exploration. When the processus vaginalis is closed, the testis is usually vanished or absent.1 We did not suspect an abdominal testis and we were deceived by the origin of the blind-ending vessels.
A similar case was reported by Zaccara et al.2 They explored a patient with a nonpalpable testis and an ipsilateral multicystic
References (3)
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Diagnosis and treatment of the intra-abdominal gonad in the pediatric population: Testes, ovaries, dysgenetic gonads, streaks, and ovotestes
2020, Journal of Pediatric SurgeryCitation Excerpt :The mechanism is likely related to lack of abdominal wall pressure to push the testicle into the inguinal canal. Peri-renal testes can be found in patients with renal anomalies such as MCDK (multicystic dysplastic kidney) [44]. Rarely the testis can even be found close to the spleen in splenogondal fusion [45].
The value of finding a closed internal ring on laparoscopy in unilateral nonpalpable testis
2013, Journal of Pediatric SurgeryCitation Excerpt :The common characteristic shared by these children was obesity. On the other hand, Kim et al. reported a missed intra-abdominal testis on laparoscopy despite blind-ending vessels and a closed processus vaginalis in a patient with ipsilateral multicystic dysplastic pelvic kidney [15]. In this case, the testis was lateral and at the superior aspect of the pelvic kidney.
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