PMC5723351_01
Clinical photograph pre operative.
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Clinically, the right testis was impalpable and left testis palpable in the left hemiscrotum with fluid hernia on the same side (Fig. 1, left side marked by yellow arrow and right side by red arrow in all figures).
(a) Ultrasonography (b) Magnetic resonance image.
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The patient had an ultrasound of the abdomen which showed both the testes on the left side with fluid hernia also on the left side (Fig. 2a). To confirm this finding, the patient underwent a MRI which reported an oval structure above the right deep inguinal ring which represents atrophic testis (Fig. 2b).
Diagnostic laparoscopy findings.
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Due to the conflicting reports, it was decided to define the anatomy better with a diagnostic laparoscopy which showed closed internal ring on the right side, a wide open internal ring on the left side, and two sets of vas and vessels entering the ring, the right sided vas and vessels seen crossing the midline onto the left side and testis seen in the canal while another testis was palpable clinically in the left hemiscrotum (Fig. 3a,b and c).
Inguinal exploration.
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This was followed by a left inguinal exploration with dissection and ligation of peritoneal sac and separation of both the testes with their vas and vessels (Fig. 4).
Clinical photograph post operative.
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Adequate cord length could not be achieved for the right testis to reach the right hemiscrotum hence we performed a trans-septal contralateral orchidopexy fixing the right testis in the left hemiscrotum with vas laterally vessels medially and testicular sinus anteromedially and left testis vice - versa (Fig. 5).