transverse testicular ectopia ( tte ) also named testicular pseudoduplication , unilateral double testis , and transverse aberrant testicular mal - descent , is a rare anomaly in which both testes descend or migrate through a single inguinal canal or hemiscrotum . we report a case of tte discovered accidentally during surgery for right inguinal hernia and bilateral undescended testes . the patient was a 7 months old infant , who admitted for the left nonpalpable testis , right undescended testis and right inguinal hernia . there was no history of illnesses or poor feeding or failure to thrive ( ftt ) . in external genitalia examination , the right testis was palpable inguinally with an evident hernia and the left hemiscrotum was empty . firstly , left inguinal incision was done , and no testicular tissue or even spermatic cord was found . the right testis with its overlying tunica vaginalis was found at the deep inguinal ring . after opening of the tunica , the fluid inside of it drained and testis was found . at the proximal part of the cord the left cord was released at the site of its bifurcation , to the most proximal site , that distal to it releasing dissection was completed . finally , the left testis was transferred with its cord to the left hemiscrotum easily and extra - peritoneally . berg   proposed the possibility of the development of both testes from the same genital ridge . kimura   concluded that if both vasa deferentia arose from one side , there had been unilateral origin but if there was bilateral origin , one testis had crossed over . gupta and das   postulated that adherence and fusion of the developing wolffian ducts took place early , and that descent of one testis caused the second one to follow . an inguinal hernia is invariably present on the side to which the ectopic testis has migrated . on the basis of the presence of various associated anomalies , tte has been classified into 3 types : type 1 , accompanied only by hernia ( 40% to 50% ) ; type 2 , accompanied by persistent or rudimentary mullerian duct structures ( 30% ) ; and type 3 , associated with disorders other than persistent mullerian remnants ( inguinal hernia , hypospadias , pseudohermaphroditism , and scrotal abnormalities ) ( 20% ) . according to that classification , . this condition may hinder the testis from being placed into the scrotum during orchiopexy . the clinical presentation generally includes an inguinal hernia on one side and a contralateral or sometimes a bilateral cryptorchidism , . usually , the correct diagnosis is not made before surgical exploration , like our case , and it is revealed during herniotomy . the diagnosis of tte can be made preoperatively by using ultrasonography   by an experienced sonologist . there have been reports of embryonal carcinoma , seminoma , yolk sac tumor , and teratoma . .   in their study concluded that testicular cancer was nearly 6 times more likely to develop in cryptorchid cases whose operations were delayed until after age 10 to 11 years . wood et al .   in their study showed that risk of malignancy in undescended testicles decreased if their orchiopexy performed before ages 10 to 12 years . in 2% to 97% of patients with crossed testicular ectopia , once diagnosis of tte is made , a conservative surgical approach in the form of orchiopexy is recommended for the preservation of fertility . management for testicular ectopia is either trans - septal or extra - peritoneal transposition orchiopexy , , a search for mullerian remnants and other anomalies , and long - term postoperative follow - up . there were two options for left orchiopexy in our case : extra - peritoneal orchiopexy and trans - septal orchiopexy . in the extra - peritoneal technique the testis is brought to the contra - lateral hemiscrotum after its passing near the root of penis . in the trans - septal technique the testis should traverse the scrotal mediastinum to be fixed in it . in the case of fused vas deferens , unlike our case , a trans - septal orchiopexy is recommended . it may be misdiagnosed as an inguinal hernia and intersex   or present as an irreducible hernia , requiring urgent surgery   . tte is a rare anomaly of which the pathogenesis remains unclear , although experimental evidence suggests that the gubernaculums may play an important role . the ectopic testis can lie in the hemiscrotum , in the inguinal canal , or at the deep inguinal ring . the diagnosis should be considered when unilateral hernia and concurrent cryptorchidism of the contralateral side are present . in suspected cases , laparoscopy and ultrasonographic evaluation laparoscopy , at present , is useful for both diagnosis and management of tte and associated anomalies .
crossed testicular ectopia ( cte)/transverse testicular ectopia ( tte ) is a rare but well known congenital anomaly , in which both gonads migrate toward the same hemiscrotum . 
 it is usually associated with other abnormalities such as persistent mullerian duct syndrome , true hermaphroditism , inguinal hernia , hypospadias , pseudohermaphroditism , and scrotal anomalies . 
 about 100 cases of transverse testicular ectopia have been reported in published studies . 
 we report a case of transverse testicular ectopia in an 8-month - old boy who presented with right inguinal hernia and nonpalpable left testis . on exploration , 
 both testes were present in the right inguinal region . 
 bilateral orchiopexy was performed by crossing the left testis in the extra - peritoneal space and ipsilateral scrotal orchiopexy . 
 the diagnosis could not be made preoperatively in most of reported cases .