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CASE REPORT
Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 64-65  

Ectopic scrotum with undescended testis


Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission23-Sep-2019
Date of Decision18-Jan-2020
Date of Acceptance11-Mar-2020
Date of Web Publication22-Jan-2021

Correspondence Address:
Aditya Pratap Singh
Near the Mali Hostel, Main Bali Road, Falna, Pali - 306 116, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_264_19

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  Abstract 


Ectopic scrotum is defined as abnormal position rather than normal position of the scrotum. Congenital scrotal anomalies are penoscrotal transposition, bifid scrotum, accessory scrotum, and ectopic scrotum. Associated anomalies with ectopic scrotum are inguinal hernia, ectopic ureter, vesical exstrophy, renal dysplasia, and agenesis. Ectopic scrotum is a rare congenital anomaly. We report a case of ectopic scrotum with undescended testis.

Keywords: Ectopic scrotum, hemiscrotum, scrotum, testis, undescended testis


How to cite this article:
Barolia DK, Singh AP, Mehra SK, Chaturvedi V, Raipuria G. Ectopic scrotum with undescended testis. Med J DY Patil Vidyapeeth 2021;14:64-5

How to cite this URL:
Barolia DK, Singh AP, Mehra SK, Chaturvedi V, Raipuria G. Ectopic scrotum with undescended testis. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Feb 27];14:64-5. Available from: https://www.mjdrdypv.org/text.asp?2021/14/1/64/307671




  Introduction Top


Ectopic scrotum is a congenital anomaly, a scrotum at aberrant position. Congenital scrotal anomalies are penoscrotal transposition, bifid scrotum, accessory scrotum, and ectopic scrotum.[1] The most common position of ectopic scrotum is the suprainguinal region. Other positions are infrainguinal and perineal regions.[2] Etiology of ectopic scrotum is not yet clear, but aberrant development of gubernaculum is accused for ectopic scrotum.[3] We present here a case of ectopic scrotum which was hypoplastic, associated with undescended testis.


  Case Report Top


A 2½-year-old male child, weighing 14 kg, was brought by his parents with chief complaint of absent left testis. He was the first child with a history of full-term normal vaginal delivery. Antenatal period was uneventful. There was no history of congenital anomalies in family. On local examination, there was hemiscrotum of the right at normal position with normal size testis. Left hemiscrotum was absent. There was a skin tag of 1.5 cm × 1 cm size, at the left suprainguinal region appearing like scrotum due to skin rugosity [Figure 1]a.There was no palpable testis in the scrotum like swelling. A left testis was palpable in the left inguinal canal. The abdomen was soft and no palpable lump. Blood investigations were normal in limits. Ultrasonography (USG) of the abdomen showed normal kidney, ureter, bladder, and other solid and hollow viscera. USG showed that the left testis was present in the inguinal canal. After getting preanesthetic fitness, he was explored for orchidopexy. Gubernaculum of the left testis was attached with a skin tag [Figure 1]b. Left orchidopexy was done at subcutaneous plane beside the right hemiscrotum. Scrotoplasty was not done because the left scrotum was hypoplastic. Hypoplastic scrotum was excised and repaired. Histopathology of the excised tag showed skin epithelium with underlying adnexal glands and fibromuscular tissues. Interstitial collagenization was present. All these histopathological findings were suggestive of hypoplastic scrotum. Postoperative period and 6-month follow-up were [Figure 1]c uneventful [Figure 1]d.
Figure 1: (a) Left ectopic scrotum at the suprainguinal region. Testis is visible in the ectopic scrotum, (b) retraction of ectopic scrotum after stretching of gubernaculums, (c) histopathology of excised ectopic scrotum showed the fibromuscular tissue with collagenization and adnexal glands (×40, H and E), (d) the orchidopexy site wound and excised ectopic scrotum wound in follow-up

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  Discussion Top


Ectopic scrotum is less frequent than bifid scrotum, accessory scrotum, and penoscrotal transposition. Scrotum develops from the labioscrotal folds which migrate to genital tubercle inferomedially. Bloom et al. postulated that aberration in development of gubernaculum may cause labioscrotal fold defect that leads to ectopic scrotum.[4] Mechanical pressure over developing scrotum site during embryological development leads to ectopic scrotum. This theory was proposed by Stephens in 1988.[5] Bawa et al. reported a case of ectopic scrotum associated with anorectal malformation and sacral agenesis supports the mechanical pressure hypothesis.[6] In our case, there was no evidence of mechanical pressure over the scrotal site. However, undescended testes along with ectopic testis prove that the hypothesis of aberrant development (of gubernaculum) may lead ectopic scrotum.

Surgical treatment of ectopic scrotum is scrotal transposition and orchidopexy.[6] Moorthy et al. reported a case of ectopic hemiscrotum containing testis. They did scrotal transposition and orchiopexy.[7] However, in our case, the scrotum was hypoplastic. Scrotal transposition was not possible; in such condition, we did orchidopexy in subcutaneous plane and excision of hypoplastic ectopic scrotum. Postoperative recovery was very satisfactory and cosmetically acceptable.


  Conclusion Top


Very few cases of ectopic scrotum were reported in the English literature till date. This is treated by scrotal transposition and orchidopexy, but when ectopic scrotum is hypoplastic, then treatment of option is subcutaneous orchidopexy at the anatomical position and excision of hypoplastic scrotum. This maintains the self-esteem and cosmetically acceptance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal.The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The authors would like to thank Dr. Neelam Dogra, MD Anaesthesia, Senior Professor, SMS Medical College, Jaipur, Rajasthan, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Macdonald MF, Spencer JB, Kass EJ. Abnormalities of the penis and scrotum. In: Kelalis PP, King LR, Belman AB, editors. Clinical Pediatric Urology. UK: Informa Healthcare; 2007. p. 1246.  Back to cited text no. 1
    
2.
Milroy E. Ectopic scrotum. A review of the litrature and report of a further case. Br J Urol 1969;41:235-7.  Back to cited text no. 2
    
3.
Spears T, Franco I, Reda EF, Hernandez-Graulau J, Levitt SB. Accessory and ectopic scrotum with VATER association. Urology 1992;40:343-5.  Back to cited text no. 3
    
4.
Bloom DA, Wan J, Key D. Disorder of male external genitalia and inguinal canal. In: Kelalis PP, King LR, Belman AB, editors. Clinical Pediatric Urology. Vol. 2, 3rd ed. Philadelphia, PA: Elsevier-Saunders; 1992. p. 1015-48.  Back to cited text no. 4
    
5.
Stephens FD. Embryology of the cloaca and embryogenesis of anorectal malformations. Birth Defects Orig Artic Ser 1988;24:177-209.  Back to cited text no. 5
    
6.
Bawa M, Garge S, Sekhon V, Rao K. Inguinal ectopic scrotum, anorectal malformation with sacral agenesis and limb defects: An unusual presentation. J Korean Assoc Pediatr Surg 2015;21:32-4.  Back to cited text no. 6
    
7.
Moorthy HK, Pillai BS, Rathore RS, Mehta N. Ectopic scrotum: A unique case report. Can Urol Assoc J 2015;9:E665-6.  Back to cited text no. 7
    


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