Transverse testicular ectopia: a case report on preoperative misdiagnosis in two siblings

Transverse testicular ectopia (TTE) is a rare congenital abnormality, with only approximately 35% of TTE cases being correctly diagnosed preoperatively. TTE is generally not considered a genetic or inherited disease, although it may occur in genetically related individuals. Here, we report two siblings who had a preoperative misdiagnosis of TTE and share our experience with their diagnosis and treatment to enhance the clinical literature on the appropriate management of TTE cases.

In June 2021, a 1-year-old boy received preoperative diagnoses of right cryptorchidism and left inguinal hernia; however, laparoscopy then corrected the diagnosis and confirmed it as right TTE with persistent Müllerian duct syndrome. Two years later, in August 2023, his younger brother was brought to the hospital and preoperatively diagnosed with right cryptorchidism and left inguinal hernia. Again, the laparoscopic procedure confirmed the diagnosis of right TTE. Both patients underwent transseptal orchidopexy (Ombredanne operation) to fix the testes inside the left and right scrotum. The patients were followed up at the clinic with no issues reported.

Ultrasound is the first diagnostic modality for suspected testicular abnormalities, but TTE can have a preoperative misdiagnosis rate up to 35%. Laparoscopy is recommended for the diagnosis of TTE. Children with a preoperative diagnosis of cryptorchidism should be carefully evaluated to rule out TTE, especially in those with an inguinal mass on the opposite side and those with siblings with TTE. Preoperative planning in children diagnosed with cryptorchidism should also consider the possibility of TTE. Once TTE is confirmed, transseptal orchidopexy (Ombredanne operation) can be performed.