Left Inguinal Canal Research Articles

Persistent mullerian duct syndrome with or without transverse testicular ectopia and testis tumours: F. Berkmen. Br J Urol 79:122–126, (January), 1997

Objective To report three patients with persistent Mullerian duct syndrome (PMDS) associated with a unilateral testicular tumour. Patients and methods Three adults with PMDS and an associated testicular malignancy were evaluated using physical examination, imaging, measurement of tumour markers, surgical exploration and chromosome analysis. Results The position of the uterus and fallopian tubes differed in all patients; one was in the scrotal sac, another in the abdomen and the third in the left inguinal canal. Two of the patients were cousins and their pedigree showed that they were probably in a sex-limited group. Both also had transverse testicular ectopia; fertility was documented in the younger patient. In all cases, the karyotype was proved to be 46, XY. Conclusion We recommend that the diagnosis of PMDS is made radiologically and that the detection of Mullerian inhibiting factor is mandatory. As malignancy does not occur in the retained Mullerian ducts, hysterectomy should not be performed at abdominal exploration, although orchidectomy should be, because orchidopexy offers only limited protection against future malignancy if performed after 2 years of age. It is not necessary to perform testicular biopsy to detect tumour in the scrotal testis in this syndrome, because an impalpable tumour can be localized by ultrasonography.

Ovarian torsion in prepubertal and pubertal girls: sonographic findings.

The purpose of this study is to report the range of gray-scale and color Doppler findings of ovarian torsion in prepubertal and pubertal girls to determine whether there is a difference in appearance between the two age groups. The study population consisted of 20 patients, 11 who were prepubertal (ages 2 days to 6 years) and nine who were pubertal (ages 12-16 years), who had gray-scale sonograms and surgical confirmation of ovarian torsion. Color Doppler studies were obtained in 14 of 20 patients. All sonograms were reviewed retrospectively by two radiologists with attention to location of the twisted ovary, internal characteristics, and evidence of color Doppler flow. The results were then compared in the prepubertal and pubertal groups. Sonographic findings of torsion in 11 prepubertal patients included complex mass with septations and debris (6/11), cystic mass (1/11), and solid mass with peripheral cysts (4/11). The masses were located in the right lower quadrant (5/11), left lower quadrant (3/11), right adnexa (2/11), and right inguinal canal (1/11). Eight of nine pubertal patients had solid masses, and one had a thick-walled cystic mass. Torsion involved the right ovary in nine patients and the left in 11. Color patterns included central flow (3/14), peripheral flow (6/14), and absence of flow (5/14) and did not correlate with age or gray-scale findings. Sonographic findings of ovarian torsion vary with age. Neonates and young children have extrapelvic cystic or complex cystic masses, whereas pubertal girls have predominantly solid masses in an adnexal location. In both groups of patients, color Doppler signal can be documented in many twisted ovaries.

A penile testis

E CTOPIC TESTES in extracanalicular locations are rather uncommon, although locations in the perineum, femoral area, buttock, and the pubopenile area have been described. The following case report describes a true penile testis. A l%yr-old male came to the Pediatric Surgery Clinic because of an asymptomatic mass on his penis present since birth. On physical examination, the mass was located in the dorsal midshaft of the penis (Fig. I). The right testicle was in the scrota1 sac and was norma,l to palpation. Upon palpation the penile mass was felt to be the same size and consistency as the right testicle. The left scrotal sac was empty and atrophic and no testicle could be felt in the left inguinal canal. There was no hernia present on either side. Cord structures could be palpated along the dorsum of the penis proximal to the penile mass and could be traced to the external inguinal ring. At operation, the cord structures were seen at the external inguinal ring extending onto the dorsum of the penis. The ectopic testis was superficial to the corpora cavernosa and to Buck’s facia There was a thin filamentous band parallel and superficial to the fundiform ligament of the penis and superficial to the cord structures, preventing their removal from this location. After division of this small band the testicle was easily retracted into the operative wound. There

Mumps Orchitis in a Three-Year-Old Child

To the Editor:— Mumps epididymoorchitis rarely occurs before puberty. We recently observed a three-year-old boy with this complication and are reporting on our experience with him. Report of a Case:— A three-year-old white male child came to the pediatric clinic on July 12, 1967, with a one-day history of left parotid swelling, low-grade fever, and gradually increasing pain in the left groin. There had been exposure to mumps in a playmate seventeen days before. On physical examination, the patient was alert and cooperative. The rectal temperature was 38 C. There was swelling and tenderness over the left parotid gland. The orifice of Stensen's duct on the left was edematous and slightly erythematous. The right parotid gland was clinically uninvolved. There was swelling, heat, and redness along the left inguinal canal and scrotum. The left testis and epididymis were enlarged and exquisitely tender. The right scrotal contents were normal to inspection

Left Inguinal Herniation of the Cecum

HERNIATION of normally located cecum into the right inguinal canal is a fairly frequent surgical finding. Migration of this structure to the left side and its herniation into the left inguinal canal, however, is extremely rare. Apparently, the only such case reported in the literature is cited by Koontz in his recent book<i>Hernia</i>.¹The purpose of this communication is to report a case of strangulated cecal herniation through the left inguinal canal which was treated successfully by emergency hemicolectomy on the right. <h3>Report of Case</h3> A 74-year-old white man was admitted to the Veterans Administration Hospital, Clarksburg, WVa, complaining of a constant pain of five days' duration in the left lower abdomen. The patient was nauseated but had a regular bowel movement the day prior to admission. He had had bilateral reducible inguinal hernias for many years. On physical examination he appeared to be in good general condition;