Congenital Spigelian Hernia With Ipsilateral Ectopic Testis.

Area of Science:

• Pediatric Surgery
• Developmental Biology
• Medical Imaging

Background:

• The link between congenital spigelian hernia and ipsilateral ectopic testis is not well-established, lacking standardized management protocols.
• Congenital spigelian hernias pose a significant risk of incarceration, necessitating prompt diagnosis and intervention.
• Pediatric surgeons and sonographers require heightened awareness of this combined anomaly.

Observation:

• A 3-month-old male infant presented with a congenital left-sided abdominal wall swelling and ipsilateral undescended testis.
• Ultrasound suggested a congenital spigelian hernia but did not locate the ectopic testis.
• At 9 months, diagnostic laparoscopy and open repair of the spigelian hernia were performed, revealing the left testis within the hernia sac.

Findings:

• The ectopic left testis was successfully located within the spigelian hernia sac during laparoscopy.
• Simultaneous left-sided orchidopexy and spigelian hernia repair were performed.
• The patient remained asymptomatic at 1-year follow-up post-surgery.

Implications:

• The spigelian hernia sac must be meticulously examined for ectopic testes during surgical repair.
• Delayed surgical intervention for orchidopexy and hernia repair may be beneficial in young children, balancing risks and benefits.
• Surgical approach (laparoscopic or open) should be individualized based on surgeon expertise and intraoperative findings.