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島 根 県 中 病 医 誌 48
4 5頁 〜 4 9頁

症 例 報 告Adhesive small bowel obstruction caused
by intraabdominal testis associatedwith a tunica albuginea cyst: A case report
Kazuya OKAMURA1） Aiko GOBARA1）Emi ISHIBASHI1）
Kazumi ARAKI1）
Yoshiko KANASAKI1）
Koji YUASA1）
Koji KODAMA1）
Akinobu KANAZAWA2） and Hideyuki ONUMA3）
Abstract：Diagnosing intraabdominal testis is important because it can cause small bowel obstruction（SBO）. There are reports of SBO caused by malignant tumors in the intraabdominal testis, but only a few
studies report SBO caused by factors other than malignant tumors. Herein, we report a case of intraabdominal
testis complicated with a tunica albuginea cyst, which caused adhesive SBO due to abdominal trauma.
Intraabdominal testis can cause recurrent SBO if not surgically removed. In our case, the SBO recurred amonth after adhesiotomy was performed, and intraabdominal testis was removed. The characteristic imaging
ﬁndings of intraabdominal testis should be known and a correct preoperative diagnosis should be made.
Key words：Small bowel obstruction（SBO）, intraabdominal testis, adhesive, cyst, male

精巣白膜嚢胞を伴う腹腔内停留精巣による癒着性小腸閉塞の一例

概岡村和弥1） 河原愛子1） 石橋恵美1） 荒木和美1） 金崎湯浅貢司1） 児玉光史1） 金澤旭宣2） 大沼秀行3）佳子1）

要：腹腔内停留精巣は小腸閉塞を引き起こす可能性があり，診断することが重要である．腹

腔内停留精巣に発生した悪性腫瘍により引き起こされる小腸閉塞の報告はあるが，悪性腫瘍以外の要因で引き起こされる小腸閉塞を報告する研究はわずかである．今回我々は，腹部外傷により癒着性小腸閉塞を引き起こした精巣白膜嚢胞を合併した腹腔内停留精巣の症例を報告する．腹腔内停留精巣は外科的に切除しない場合には再発性の腸閉塞を引き起こすことがある．我々の症例でも腸閉塞の癒着解除術の１か月後に腸閉塞を再発し，腹腔内停留精巣の切除術が施行されている．腹腔内停留精巣の特徴的な画像所見を把握し，正確な術前診断を行う必要がある．
索引用語：腸閉塞，腹腔内停留精巣，癒着，嚢胞，男性Introduction
An undescended testis, also known as cryptorchidism,

１）島根県立中央病院
２）島根県立中央病院
３）島根県立中央病院

放射線科
消化器外科
病理組織診断科

can be classified into prescrotal, intracanalicular, andintraabdominal types according to their location. Amongthese, intraabdominal testis is the rarest and can cause

１）Shimane Prefectural Central Hospital, Department ofRadiology２）Shimane Prefectural Central Hospital, Department ofGastrointestinal Surgery３）Shimane Prefectural Central Hospital, Department ofDiagnostic Pathology

島根県立中央病院医学雑誌

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第48巻（令和５年）

small bowel obstruction（SBO）or recurrent SBO eventomography（CT）at another hospital. Contrast-enhanced

without a malignant tumor, therefore it is necessary toCT was performed in our hospital, and adhesive SBO

1）

was suspected（Fig. 1）. He had no history of surgery, but

determine characteristic imaging ﬁndings .

Intraabdominal testis may be associated with a tunica

had an abdominal trauma. A solid mass with calciﬁcation

2）

albuginea cyst in rare cases . A tunica albuginea cyst is aand cyst was found near SBO, and the mass and small

benign extratesticular cyst that develops in the albuginea

bowel were in proximity （Fig. 1 ）. Hence, SBO wasof the testis.

assumed to be caused by adhesion. CT showed no left

Herein, we report a rare case of SBO in which a tunica

testis（Fig. 2A）, and the solid part of the intraabdominal

albuginea cyst associated with intraabdominal testis

mass had a similar shape and contrast eﬀect as the right

ruptured due to abdominal trauma, causing adhesive SBO.

testis（Fig. 2B）. Additionally, since the vein originatedfrom the mass（Fig. 3）and ﬂowed into the left renal vein,

Case report

it was considered as the left testicular vein. Therefore,

A 74-year-old male patient presented with abdominal

the patient was diagnosed with adhesive SBO caused bypain and vomiting. SBO was suspected by plain computed

an intraabdominal testis. Adhesiotomy was performed,Fig. 1

Contrast-enhanced computed tomography（CT）
image（coronal image, early phase）.
Contrast-enhanced CT revealed a distended
small bowel and a solid mass with calciﬁcation
and a cyst at the margin（arrow）.

Fig. 2

A: Contrast-enhanced computed tomography（CT）image（axial image, early phase）atthe left inguinal region level.
B: Contrast-enhanced CT image（axial image, early phase）at the mass level.
CT showed no left testis in the inguinal region, and the solid part of the mass had
the same morphology and enhancement eﬀect as the right testis（A, B, arrow）. The
spermatic cord was absent in the left inguinal canal（A, arrowhead）.

Fig. 3Contrast-enhanced computed tomography（CT ）image（coronal image, late phase）.
CT showed that the testicular vein originatingfrom the intraabdominal mass（arrow）.

Adhesive small bowel obstruction caused by intraabdominal testis associated with a tunica albuginea cyst: A case report

47

Fig. 4

Pathological examination:
A: Intraabdominal testis in hematoxylin and eosin stain with low magniﬁcation.
B: A tunica albuginea cyst in hematoxylin and eosin stain with low magniﬁcation.
C: Hemosiderin-phagocytic macrophages in hematoxylin and eosin stain with high magniﬁcation.
The pathological examination revealed testicular tissue within the mass（A）. The mass was associated with a tunica
albuginea cyst（B）, and the cyst contained hemosiderin-phagocytic macrophages（C）.

but the intraabdominal testis was not resected. A month

into prescrotal, intracanalicular, and intraabdominal types,

later, SBO recurred. Reoperation was performed, andwith the intraabdominal type being the rarest. Undescended

the mass was resected together with an adherent small

testis usually requires surgery because it is predisposedbowel. Pathological diagnosis revealed an intraabdominal

to trauma, torsion, infertility, and malignancy5）. The risk

testis with a tunica albuginea cyst（Fig. 4A, 4B）, withof developing testicular cancer is 4–8 times higher in

no malignant tumor. Calciﬁcation was observed in theundescended testis, and several studies report teratoma

tunica albuginea cyst, and hemosiderin-phagocytic

before puberty and seminoma after puberty6, 7）.

macrophages were observed within the cyst （Fig. 4C）,

Intraabdominal testis has a higher incidence of tumors,suggesting the possibility of a previously ruptured cyst.

and cases of bowel obstruction caused by malignant tumor

Abdominal trauma was assumed to cause leakage of theinﬁltration or mechanical exclusion have been reported 8, 9）.

tunica albuginea cyst contents, leading to inﬂammation

However, few studies report bowel obstruction caused byand adhesions. Thereafter, adhesive SBO recurred but

factors other than malignant tumors. Only a few studies

was relieved in a short period by conservative treatment

report adhesions, adhesion-associated internal hernia,

with an indwelling ileus tube. No recurrence of SBO has

undescended testis torsion, and enlargement-induced

occurred in the subsequent 2-year follow-up.

mechanical retraction1, 10, 11, 12）. No previous studies reportadhesive SBO triggered by abdominal trauma, similar toDiscussion

this case.

The testicles descend from the abdominal cavity toW e di a gnos e d a dhe s i ve SB O c a us e d by a n

the scrotum during fetal life in males and are positioned

intraabdominal testis by CT. We conﬁrmed that the solid

within the scrotum at birth. However, it may remain on

mass in the abdominal cavity had a similar shape anda descending path and is called an undescended testis.

contrast eﬀect to the testis, and that the testis did not exist

The incidence of undescended testis is 2% – 4% at

in the left inguinal region. Additionally, preoperative

3）

birth and decreases to 0.8% by 1 year of age . Genetic,

diagnosis is possible by confirming dilated testicularmaternal, and environmental factors are thought to cause

arteries and veins, and a lack of spermatic cord in the4）undescended testis, but the exact cause is unknown .

inguinal canal by CT if a testicular tumor develops in an

Additionally, low birth weight and premature babies are

intraabdominal testis13, 14, 15）. The testicular vein originatedconsidered at risk4）. The undescended testis is classiﬁed

from the mass and ﬂowed into the left renal vein in this島根県立中央病院医学雑誌48

第48巻（令和５年）

case, and the spermatic cord was absent in the left inguinal
canal. Therefore, intraabdominal testis can be diagnosed
even in cases without a tumor. However, making an
imaging diagnosis for intraabdominal testis may be
diﬃcult if intraabdominal testis is not recognized to beincluded in the diﬀerential diagnosis of intraabdominal
masses in males. The intraabdominal testis can be correctly
diagnosed based on this recognition if the characteristic
imaging ﬁndings are conﬁrmed as described above.
Moreover, intraabdominal testis has been reported
to cause recurrent intestinal obstruction and is likely
to have recurrent intestinal obstruction episodes if not1）

surgically resected . Surgical removal is desirable if
the surgeon ﬁnds that the intraabdominal testis causes
SBO during surgery 1）. In our case, adhesiotomy was alsoFig. 5

A: Contrast-enhanced computed tomography （CT ） image（coronal image, late phase）.
B : Contrast-enhanced CT image（sagittal image, late phase）.
A unilocular cystic mass was found outside the testis（arrow）.

performed, but the intraabdominal testis was not resected,
and intestinal obstruction recurred; thus, reoperationa tunica albuginea cyst ruptured due to abdominal

was performed. A radiologist must correctly diagnose

trauma. When a tunica albuginea cyst ruptures, the cyst

SBO caused by an intraabdominal testis and recommend

collapses and surrounding inflammatory changes aresurgical resection.

seen on imaging findings. However, no such change

Furthermore, the intraabdominal testis in our case waswas observed in this case. If some time has passed after

associated with a tunica albuginea cyst. A tunica albuginea

rupture, imaging ﬁndings that suggest rupture may not

cyst is a benign extratesticular cyst that develops in thebe obtained. In addition, there are no study reports oftunica albuginea of the testis. It has uniform margin andadhesive SBO caused by intraabdominal testis triggered16）

by abdominal trauma. Therefore, if an intraabdominal

It may be unilocular or multilocular . It was previously

testis is not complicated with a tunica albuginea cyst, it

presumed to be related to trauma and inﬂammation, but

is unlikely that abdominal trauma causes SBO. However,16）

now the theory of congenital occurrence is dominant .

an intraabdominal testis can cause SBO even without

It can be diagnosed by the cyst location in the scrotum

abdominal trauma, so it is necessary to accurately diagnose

by ultrasound or magnetic resonance imaging althoughit.

interior and is 1–2 cm in size, rarely exceeding 4 cm .
17）

it may need to be diﬀerentiated from a simple testicular16）

In conclusion, an intraabdominal testis associated withcyst . A unilocular cystic mass of 1.5 cm in diametera tunica albuginea cyst causes an adhesive SBO due towas found outside the testis in our case（Fig. 5A, 5B）.

abdominal trauma in this case. It is critical to diagnose

The large-size mass may be diﬀerentiated by CT. ThereSBO correctly caused by an intraabdominal testis based on

have been no reports of imaging ﬁndings that clearly

typical imaging ﬁndings.

show their positional relationship although studies
report the association between tunica albuginea cyst andReferences

intraabdominal testis. Ultrasound is used for diagnosis

１）S a t o s k a r S , K a s h y a p S , Z i e h m J , e t a l . :in the scrotum, but the diagnosis may be diﬃcult if it is

Cryptorchidism as an obscure cause of adhesive small

associated with an intraabdominal testis; thus, it is usefulbowel obstruction in an adult, a case report. Int J

to conﬁrm extratesticular cyst by CT.

Surg Case Rep, 2021; 86: 106319.

This case was an extremely rare case in which

２）Iwata K, Ito A, Hirabayashi N: Cyst of the tunica

Adhesive small bowel obstruction caused by intraabdominal testis associated with a tunica albuginea cyst: A case report
albuginea associated with intraabdominal testes: acase report. Acta Urol Jpn, 1997; 43（12）: 891-894.
３）Hutson JM, Balic A, Nation T, et al.: Cryptorchidism.
Semin Pediatr Surg, 2010; 19（3）: 215-224.

4911）Kim CW, Min GE, Lee SH: Small bowel obstruction
caused by cryptorchidism in an adult. Ann Surg TreatRes, 2017; 93（5）: 281-283.
12）Sangwan MK, Sangwan V, Garg MK, et al.: The４）Kurahashi N, Kishi R: A review of epidemiologicaltorsed intraabdominal testis presenting with astudies about the incidence and etiological factors

mechanical large intestinal obstruction-A maiden caseof cryptorchidism relevance to endocrine-disrupting

report. IJCR, 2019; 4（3）: 82.

chemicals. Nippon Eiseigaku Zasshi （Jpn J Hyg）,
2003; 57（4）: 636-644.

13）Altinkilic B, Lommel D, Franke FE, et al.: Seminoma
in an intra-abdominal testis was misdiagnosed as a５）Nik H, Kishen R, Azuddin MK: A rare cause

kidney tumor and associated with ipsilateral renalof mechanical obstruction: a case report ofagenesis. Scand J Urol Nephrol, 2003; 37（2）: 181-

cryptoorchidsm in adults. Int Surg J, 2020; 7（11）:183.

3790-3791.

14）Karcaaltincaba M, Kaya D, Ozkan OS, et al.:６）Manecksha RP, Fitzpatrick JM: Epidemiology ofPreoperative multidetector computed tomography

testicular cancer. BJU Int, 2009; 104（9b）: 1329-1333.

diagnosis of a seminoma originating from an７）Gupta A, Kureel SN, Bhalla S, et al.: Yolk sac tumor

undescended testis bytesticular vascular pedicle

in intraabdominal undescended testis in a child withsign. J Comput Assist Tomogr, 2006; 30（5）: 794-

normal serum alpha-fetoprotein: a rare case report.

795.

Afr J Urol, 2020; 26（1）: 1-5.

15）Jeong MJ, Kim SH, Kim JY, et al.: Radiological８）Ciftci F, Benek S, Kezer C, et al.: A rare cause ofclues for diagnosing intra-abdominal seminoma inmechanical intestinal obstruction: a neoplastic intra-undescended testis on computed tomography. Radiolabdominal testis. Int Surg, 2016; 101（3-4）: 167-170.

Case Rep, 2022; 17（6）: 2273-2276.

９）Takemura S, Yui S: Seminoma originating in an16）Matsumura N, Sugimoto K, Hayashi T, et al.: Cyst ofundescended testis in the abdominal space presenting

the tunica albuginea testis: a case report. Acta Urolas ileus: a case report. J Jpn Soc Coloproctol, 2012;

Jpn, 2015; 61（2）: 71-74.

65（1）: 16-21.
10）Bassiouny IE, Abbas TO, Alansari AN, et al.: Uniquepresentation of intra-abdominal testis: small bowel17）Alvarez DM, Bhatt S, Dogra VS: Sonographic
spectrum of tunica albuginea cyst. J Clin Imaging Sci,
2011; 1: 5.

obstruction. ISRN Urol, 2011; Artile ID 579153: 3pages.

（受付日：2023年10月11日，掲載決定日：2023年12月15日）