Perineal discomfort caused by the sitting position as a rare manifestation of ectopic testicle: About two cases

• Published in: International journal of surgery case reports Vol. 120; p. 109919
• Main Authors: Ammar, Sabrine Ben, Hidouri, Saida, El Mansouri, Yosra, Boukadi, Alia, Chaouch, Mohamed Ali, Mosbahi, Sana
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-07-2024
• Subjects: Child; Cryptorchidism; Orchidopexy; Perineal discomfort; Perineal ectopic testis; Cryptorchidism; Child; Perineal ectopic testis; Orchidopexy; Perineal discomfort
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109919

Perineal ectopic testis (PET) is a rare congenital anomaly; the diagnosis is typically made by conducting a physical examination of the ectopic areas and noting an empty scrotum on the corresponding side. We report two pediatric cases of PET in whom this condition was diagnosed by a discomfort induced by the sitting position.
Two cases of PET were operated on in our pediatric surgery department over the past three years. Patients were referred for perineal discomfort in the sitting position. Children had difficulty staying seated at home or school, this was described by parents as an abnormal fussiness after sitting. The age at diagnosis was five and three years. The diagnosis of perineal testicular ectopia was made through physical examination. Orchidopexies to the corresponding scrotum were performed in both cases via an inguinal approach. No postoperative complication was noted with a follow-up of 24 months.
PET is typically diagnosed through clinical examination, characterized by an empty scrotum and a palpable perineal mass. The exact aetiology is unclear, but it involves abnormalities in testicular descent mechanisms, particularly the gubernaculum. PET can cause perineal discomfort when sitting, a symptom observed in the two pediatric cases presented. Early surgical intervention via orchidopexy is crucial to prevent complications. Both reported cases were successfully treated with no postoperative complications and resolution of discomfort. Prompt diagnosis and treatment are essential for preserving testicular function.
Perineal discomfort on sitting was the defining diagnostic element in our cases. In practice, this symptom should be a prompt for a thorough perineal examination in children with an empty scrotum. However, the patient's age and ability to express himself determine the significance of the symptom.
•Perineal ectopic testis (PET) is a rare congenital anomaly, often diagnosed by the presence of an empty scrotum and a palpable perineal mass, with unique symptoms such as perineal discomfort when sitting.•Prompt clinical examination and early surgical intervention via orchidopexy are essential to prevent complications like testicular atrophy, malignancy, torsion, and infertility, ensuring better long-term outcomes.•In the reported cases, both pediatric patients underwent successful orchidopexy with no postoperative complications and complete resolution of perineal discomfort, highlighting the effectiveness of timely surgical management for PET.