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LETTER TO THE EDITOR
Year : 2016  |  Volume : 21  |  Issue : 1  |  Page : 44-45
 

Undescended testis and swelling in Spigelian belt: Not always a spigelian hernia


Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India

Date of Web Publication17-Dec-2015

Correspondence Address:
Shailendra Pal Singh
Department of Surgery, Uttar Pradesh Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.154660

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How to cite this article:
Pandey A, Gupta V, Singh SP, Verma R. Undescended testis and swelling in Spigelian belt: Not always a spigelian hernia. J Indian Assoc Pediatr Surg 2016;21:44-5

How to cite this URL:
Pandey A, Gupta V, Singh SP, Verma R. Undescended testis and swelling in Spigelian belt: Not always a spigelian hernia. J Indian Assoc Pediatr Surg [serial online] 2016 [cited 2019 Sep 15];21:44-5. Available from: http://www.jiaps.com/text.asp?2016/21/1/44/154660


Sir,

Ectopic testis (ET) is a type of undescended testis (UDT) where the testis deviates from its normal path of descent and migrates to some other site. [1] There are certain sites where an ET has classically been described. These include femoral, pubopenile, perineal, and transverse ectopic testis. [1] However, an ectopic testis in the abdominal wall is reported only once. [2] It may be associated with inguinal hernia. In an extremely rare situation, an inguinal hernia, associated with an ectopic testis in the abdominal wall, may masquerade  Spigelia More Detailsn hernia (SH).

A 5-month-old male child was referred to us with complaint of a right inguinal swelling and left flank swelling for last four months. We also noticed left UDT, which the parents failed to notice [Figure 1]a. The left flank swelling appeared like a spigelian hernia. On examination, both the swellings were reducible. However, on reducing the left swelling, the origin appeared to be at the deep inguinal ring. We were also able to feel testis like structure inside the flank swelling.
Figure 1: (a) It shows a right inguinal hernia and left flank bulge, suggestive of a spigelian hernia. There is left undescended testis (b) It shows the sac present in the subcutaneous space. The incision is in the lower inguinal crease (c) The testis is present inside the sac (d) Testis after full mobilization. The peritoneal sac is closed at the deep inguinal ring

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After right herniotomy, we made an incision in left lower inguinal crease. After dividing the subcutaneous tissue, we noticed a sac like structure coming out through the deep ring and going towards anterior abdominal wall in the subcutaneous plane [Figure 1]b. After retrieving the sac, we mobilized it toward its origin at the deep ring. There was no other muscular defect anywhere.

When we opened the sac, the testis was present inside it. The testis was mobilized and separated carefully from the sac [Figure 1]c. The hernia sac was repaired carefully [Figure 1]d, and the left orchiopexy was performed. Post-operative period was uneventful, and the patient was discharged in satisfactory condition.

The first look of the swelling is easily mistaken for a SH. Most of SHs occur in the lower abdomen where the posterior sheath is deficient. [3] SH is very rare in children, and only 59 pediatric cases have been reported up until 2012. [4]

SH has been found to be associated with UDT. [4] It has been suggested that SH is the primary defect and the undescended testis takes the path of least resistance to descend and lie in the hernial sac accounting for this association. [4] Besides this, absence of gubernaculum or UDT being the primary anomaly and secondarily causing the development of SH has also been suggested. [4],[5]

In a SH, the fascial defect is in the muscle layer, which was not present in this patient. In SH, the sac lies in between the muscle layers and not the subcutaneous plane. The incision is made over the swelling. In our patient, the sac was in the subcutaneous space, and we made a lower inguinal crease incision to repair it. Besides the defect at the deep ring, there was no other muscular defect in our patient.

This abnormal presentation needs careful clinical evaluation and proper surgical management for good outcome. This can rightly be regarded as a new location of the ectopic testis.

 
   References Top

1.
Hutson JM. Undescended testis, torsion, and varicocele. In: Coran AG, Adzick NS, Krummel TM, Laberge J, Shamberger RC, Caldmone AA, editors. Pediatric Surgery. 7 th ed. Philadelphia: Elsevier Saunders; 2012. p. 1003-20.  Back to cited text no. 1
    
2.
Pandey A, Rawat J, Pandey J, Singh S, Gopal SC. Abdominal wall ectopic testis mimicking spigelian hernia. J Pediatr Surg 2011;46:415-6.  Back to cited text no. 2
    
3.
Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M, Chowbey PK. Diagnosis and management of Spigelian hernia: A review of literature and our experience. J Min Access Surg 2008;4:95-8.  Back to cited text no. 3
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4.
Parihar D, Kadian YS, Raikwar P, Rattan KN. Congenital spigelian hernia and cryptorchidism: Another case of new syndrome. APSP J Case Rep 2013;4:41.  Back to cited text no. 4
    
5.
Rushfeldt C, Oltmanns G, Vonen B. Spigelian-cryptorchidism syndrome: A case report and discussion of the basic elements in a possibly new congenital syndrome. Pediatr Surg Int 2010;26:939-42.  Back to cited text no. 5
    


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