Penopubic testicular ectopia with bilateral cryptorchidism presenting as obstructed inguinal Amyand’s hernia

Testicular ectopia is an aberrant deviation of the migration of the testis from its usual path of descent into the scrotum. Of the forms of ectopic testis, the penopubic (also called pubopenile) type is one of the least common; in this case, presented as an obstructed hernia. We report a rare case of penopubic testicular ectopia with bilateral cryptorchidism in a 17-year-old boy who presented to the emergency room with right obstructed inguinal hernia. Intraoperative findings included bilateral cryptorchidism, hernia sac with right undescended testis and normal vermiform appendix, a left penopubic testis abutting the hernia sac. Both testes had separate epididymides and adequate length of vasa deferentia and were transposed into their respective hemiscrotum via an open inguinal approach. The patient had an uneventful recovery. Penopubic testicular ectopia can present as obstructed Amyand’s hernia. Early open groin exploration with orchidopexy was satisfactory.

PERINEAL ECTOPIC TESTIS - A RARE ANOMALY WITH EMPTY SCROTUM

Undescended testis is a very common presentation in male paediatric population but testis at ectopic sites is a very rare pathology. One of the ectopic sites is perineum and it accounts for only 1% of all cases of undescended testis. We report a case of an 11yr old boy who presented with an empty left hemiscrotum and detailed examination revealed a soft tissue mass on the corresponding side in the perineum. Surgical exploration was carried out during which it was revealed that mass was actually testis at ectopic site with adequate length of the spermatic cord. Testis was mobilized and fixed in the ipsilateral hemiscrotum.

FEMORAL HERNIA MASQUERADING AS ACUTE GROIN PAIN: A DIAGNOSTIC AND SURGICAL CHALLENGE

Femoral hernia is a type of groin hernia, where the content protrudes through the femoral ring. Common contents in femoral hernias are, preperitoneal fat and small bowel, in some rare cases, sac containing an appendix, Meckel's diverticulum, ectopic testis, and stomach are reported.1 A femoral hernia presents as a mass or bulge below the inguinal ligament. Sometimes, femoral hernia presents as a bulge over the inguinal canal. In this case, the femoral hernia still exits inferior to the inguinal ligament through the femoral canal but ascends in a cephalad direction.2 Sometimes, femoral hernias may present in an occult manner with unexplained pain in the groin. We report a single case of Richter’s type strangulated femoral hernia at a tertiary care apex institution of Eastern India. This case of femoral herniation presented atypically as groin pain without any swelling initially. This was followed by swelling with pain at the groin above the inguinal ligament after a few days.

Inguinoscrotal swellings in childhood: a clinico-diagnostic approach to differential diagnosis

Background: Inguinoscrotal diseases are one of the commonest group of disorders seen in clinical surgical practice. A wide range of swellings are seen in this region in children and includes hydrocele, torsion testis, ectopic testis, lymphadenopathy, inguinal hernias, cysts, epididymitis, orchitis, tumors etc. Vigilant clinical and radiological evaluation of inguinoscrotum for varying diseases helps in proper diagnosis and surgical management of its differential diagnosis.Methods: The present study was conducted as an observational study over a period of 10 months and enrolled a total of 50 patients.Results: In this study, 31 cases had hydrocele, 14 cases had inguinal hernia, 2 cases had epididymorchitis, 2 cases had lymphadenopathy and one case had idiopathic scrotal edema. Individual diseases had varying presentations, clinical findings and post-operative findings.Conclusions: There is a varying broad spectrum of swellings in the inguinoscrotal region in young male children. It was concluded that proper clinical and radiological evaluation of the patient helps to timely diagnose the disease and hence help in identifying correct approach to the management of the case.