Introduction: Total unilateral ectopy of the scrotum can be defined by the abnormal congenital anatomical position of the scrotum and its contents. The aim of the study is to describe the diagnostic and therapeutic approach of a total unilateral ectopy of the right scrotum. Methods: This is a clinical observation of a 46-year-old patient with a right abdominal mass evolving from birth. Analyzing the cluster of arguments clinically, operatively and anatomopathologically, allowed us to retain the diagnosis of a total unilateral ectopy of the right scrotum. The informed consent of the patient was obtained before the use of the images for scientific purposes. Conclusion: the unilateral total ectopy of the right scrotum is a rare congenital malformation of the external genitalia, which clinical diagnosis is difficult. Its management is surgical.
The scrotum is an even organ, normally located below the penis and the anterior part of the perineum [
Mr XY, 46 years old, monogamous, with 8 children, 6 of whom are in live, had consulted for a swelling sitting on the right flank and right inguinal region [
After informed consent of the patient, a surgical exploration was decided and executed. The surgical procedure was performed under general anesthesia with orotracheal intubation. It has been allowed to individualize: a hernia, to the article of normal size and consistency to the skin by a ligament [
we choose to reduce the hernia and close the collar. Secondly, we had cut the suspensory ligament (gubernaculum testis) and proceeded with the “skeletonization”
of the cord allowing to obtain a length judged sufficient in anticipation of an orchidopexy. In a third step, we proceeded to a digital drilling of a subcutaneous tunnel from the lower angle of the abdominal cut to the left scrotum. Through a cutaneous incision of the envelopes of the left scrotum we introduced a clamp of Bengolea which came to catch the ectopic testicle and proceed to an orchidopexy in the left scrotum. The excess skin of the right abdomino-pelvic was excised and the piece addressed for pathological analysis. The histological analysis confirmed that it was a scrotal skin with its different envelopes. The results were simple with a functional result (normal spermogram, normal coitus, and a satisfactory aesthetic [
Sexual differentiation begins from the end of the fourth week of intrauterine life. The SRY [
differentiation of the extragonadal genital tract then the external genital organs. The presence of the testis in an ectopic scrotum defines the total ectopy of the scrotum. Like the malformation anomaly of the external general organs, it should be discovered by examining the newborn on the delivery bed or during the first consultations in pediatrics.
The literature always emphasizes the risk of cancer and the hypofertility of the ectopic testis. The patient is the father of 8 children, despite the ectopic position of the testicle contained in an ectopic scrotum. Note that this ectopic testicle individualized in peroperative is of normal aspect. The extra-abdominal presence of the ectopic bursa (such as a diverticulum producing an abdominal skin addition image) undoubtedly confers on the testicle a normal temperature as if it were in a normal bursa (below the penis and perineum). We therefore understand that this patient is fertile and does not present any risk of cancer of his ectopic testicle despite his advanced age of 46 years. Testicular cancer is rare, accounting for 1% to 1.5% of the total human cancer and generally affects young people aged 15 - 35 years [
Cryptorchidism, testicular ectopy and penoscrotal transposition are the anomalies of the external genitalia well known to researchers as reported by multiple publications and benefit from a well-codified management today. The unilateral total ectopy of the scrotum that we describe is unusual since it is an ectopy of the scrotum and its contents. The lack of publication on this anomaly is evidence of its rarity. The evidence for the unilateral total ectopy of the scrotum comes from an analysis of a set of arguments below. The presence of a mass although of abdominopelvic seat, covered with a pleated skin and endowed with elasticity such as a scrotal skin in normal position. The absence of the medial raphe on the contralateral scrotum in normal position, with a testicle in a normal position. The intraoperative discovery of a testicle attached to the skin of the ectopic scrotal mass by the gubernaculum testis. Finally, the histological evidence of this scrotal skin is a further argument in favor of total scrotal ectopy. If all the elements concur in confirming the total unilateral ectopy of the scrotum, the challenge is to find an embryonic theory, given the enormous difficulties in finding a theory that is imposed on the others among the multiples that try to explain the frequent malformation anomalies (penoscrotal transposition, testicular ectopy).
The unilateral total ectopy of the right purse is a rare disease; its discovery is oriented by the symptomatology. The surgical treatment must, as far as possible, preserve the testicle.
Rimtebaye, K., Ouchemi, C., Tashkand, A.Z.A., Sillong, F.D., Mpah, E.H.M., Kaboro, M., Niang, L. and Gueye, S.M. (2017) Diagnostic Approach and Management of a Unilateral Total Ectopy of the Scrotum. Open Journal of Urology, 7, 139- 145. https://doi.org/10.4236/oju.2017.79017