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    Oup Accepted Manuscript 2020

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    Rizka Desti Ayuni

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    © All Rights Reserved
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    Oup Accepted Manuscript 2020

    Uploaded by

    Rizka Desti Ayuni
    23 views3 pages

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    oup-accepted-manuscript-2020

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    23 views3 pages

    Oup Accepted Manuscript 2020

    Uploaded by

    Rizka Desti Ayuni

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Journal of Surgical Case Reports, 2020;3, 1–3

    doi: 10.1093/jscr/rjaa027
    Case Report

    CASE REPORT

    A case of peeping testis moving from the inguinal

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    position into the abdomen
    Yukihiro Tatekawa*
    Department of Pediatric Surgery, Saku Central Hospital Advanced Care Center, Nagano, Japan
    *Correspondence address. Department of Pediatric Surgery, Saku Central Hospital Advanced Care Center, 3400-28, Nakagomi, Saku-shi,
    Nagano 385-0051, Japan. Tel: +81-267-62-8181; Fax: +81-267-88-7354; E-mail: [email protected]

    Abstract
    We report herein a 14-month-old boy with a left-sided peeping testis. At the age of 1 month, the left testis was palpated between
    the inguinal canal and the scrotum. When he was 6 months old, ultrasonography showed the left testis in the inguinal canal.
    At the age of 13 months, the left testis was not palpable. At the age of 14 months, he underwent surgery for a planned inguinal
    orchidopexy with a preoperative diagnosis of an undescended testis. When the inguinal canal was opened, a patent processus
    vaginalis was observed and the testis was found inside the abdominal cavity. The patent processus vaginalis was closed, a
    dartos pouch was created and the testis was guided into the pouch and fixed to its wall. We describe a case of a peeping testis
    moving from the inguinal position into the abdomen.

    with a preoperative diagnosis of an undescended testis. When


    INTRODUCTION
    the inguinal canal was opened, only a patent processus vaginalis
    An undescended testis (cryptorchidism) remains in the abdomen was visible (Fig. 2). After incision of the membrane, we were
    or the groin instead of descending into the scrotum. Retractile able to retrieve the testis from the abdominal cavity (Fig. 3a).
    testes descend into the scrotum but can easily move back into The patent processus vaginalis was closed, a dartos pouch was
    the inguinal canal as a reflex response to stimulation. Peeping created and the testis was guided into the pouch and fixed to its
    testes are nonpalpable and are able to move from the abdomen wall (Fig. 3b).
    into the inguinal canal with the application of intra-abdominal
    pressure [1].
    DISCUSSION
    This case report describes a patient with peeping testis that
    CASE REPORT
    was not suspected prior to surgery. Between October 2015
    A14-month-old boy was admitted to our hospital to undergo and October 2019, we operated on 72 patients with retractile
    inguinal orchidopexy. At the age of 1 month, the left testis was testes and 56 patients with undescended testes. Of the patients
    palpable between the inguinal canal and the scrotum. When he with undescended testes, two developed an intra-abdominal
    was 6 months old, ultrasonography showed the left testis inside testis and one had a peeping testis. In the 72 patients with
    the inguinal canal (Fig. 1). At the age of 13 months, the patient retractile testes, 47 underwent trans-scrotal orchidopexy and
    was seen in the outpatient clinic for preoperative examination 25 underwent inguinal orchidopexy. The 56 patients with true
    in preparation for inguinal orchidopexy; the left testis was not undescended testes underwent inguinal orchidopexy, and the
    palpable at that time. At the age of 14 months, we began surgery two patients with intra-abdominal testes underwent 2-stage

    Received: December 21, 2019. Accepted: February 6, 2020


    Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.
    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/
    licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
    For commercial re-use, please contact [email protected]

    1
    2 Y. Tatekawa

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    Figure 1: Ultrasonography (6 months of age). The left testis is located within the
    inguinal canal.

    Figure 3: Intraoperative photography (14 months of age). (a) The testis is retrieved
    from the abdominal cavity. (b) After the patent processus vaginalis is closed, the
    testis is guided into a dartos pouch and fixed to the pouch wall.

    Figure 2: Intraoperative photography (14 months of age). After opening the ingui-
    nal canal, only a patent processus vaginalis is visible.
    position. Patients with undescended testicles associated with
    inguinal hernias have a risk for torsion and should undergo
    repair by 2 years of age. Regular ultrasonography is useful to
    Fowler–Stephens orchidopexy. Of 128 patients with nonpalpable investigate the location of the testis and the existence of an
    testes in the scrotum, only a single patient at our institution had inguinal hernia.
    a peeping testis.
    Current guidelines recommend that orchidopexy for unde-
    scended testis should be undertaken before 2 years of age AUTHOR DISCLOSURE STATEMENT
    because of the risk for torsion, infertility and malignant
    transformation [1]. The incidence of torsion in undescended No competing financial interests or funding exists in connection
    testes is thought to be higher than in scrotal testes [2–6]. with this manuscript.
    The literature describing torsion of an undescended testicle
    is mostly limited to case reports [7–8]. In the largest case series CONFLICT OF INTEREST STATEMENT
    concerning testicular torsion in the inguinal canal, the mean
    None declared.
    patient age was 29.15 ± 20.21 months, a higher age than the usual
    recommended age for treatment [8]. Torsion inside the inguinal
    canal is associated with the presence of an inguinal hernia
    [9]. In a report describing the long-term outcome of patients REFERENCES
    with retractile testis, 14.1% developed an undescended testis or 1. Denes FT, Saito FJ, Silva FA, Giron AM, Machado M, Srougi M.
    experienced a decrease in testicular size requiring orchidopexy. Laparoscopic diagnosis and treatment of nonpalpable testis.
    The risk of these complications is higher in patients diagnosed Int Braz J Urol 2008;34:329–35.
    at a younger age (1.3 ± 0.9 years) [10]. 2. Williamson RC. Torsion of the testis and allied conditions. Br
    Peeping testes are primarily located in the intra-abdominal J Surg 1976;63:456–76.
    position, descending into the inguinal canal with application 3. Watkin NA, Reiger NA, Moisey CU. Is the conservative man-
    of intra-abdominal pressure. Peeping testis is usually asso- agement of the acute scrotum justified on clinical grounds?
    ciated with the presence of an inguinal hernia; it returns Br J Urol 1996;78:623–7.
    to its original intra-abdominal position by pressing on the 4. Memon AS, Siddiqui FG. Cryptorchid testicular tumour pre-
    inguinal region externally [1]. In our patient, the testis moved senting with torsion. J Coll Physicians Surg Pak 2003;13:
    spontaneously from the inguinal position to the intra-abdominal 118–9.
    Peeping testis by inguinal orchidopexy 3

    5. Zilberman D, Inbar Y, Heyman Z, Shinhar D, Bilik R, Avigad 8. Şener NC, Bas O, Karakoyunlu N, Ercil H, Yesil S, Zengin K,
    I, et al. Torsion of the cryptorchid testis—can it be salvaged? et al. A rare emergency: testicular torsion in the inguinal
    J Urol 2006;175:2287–9. canal. Biomed Res Int 2015;2015:320780.
    6. Guta D, Leduc F, Herman D. Acute abdominal pain: 9. Virtanen HE, Toppari J. Epidemiology and pathogenesis of
    the importance of genital examination. Acta Chir Belg cryptorchidism. Hum Reprod Update 2008;14:49–58.
    2011;111:398–9. 10. Bae JJ, Kim BS, Chung SK. Long-term outcomes of retractile
    7. Sheref YM, Johnson MH, Traxel EJ, Khanna G. Case report: testis. Korean J Urol 2012;53:649–53.
    torsion of a cryptorchid testicle in an infant. Emerg Radiol
    2011;18:487–9.

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