Filipovic et al. Journal of Medical Case Reports 2012, 6:267 http://www.jmedicalcasereports.com/content/6/1/267 Page 2 of 3 Figure 1 The photo and schematic approach of the case. TA1 and TA2. Medial and lateral testicular arteries. ARA – accessory renal artery. LRA – left renal artery. SRG – part of the suprarenal gland pierced by the lateral testicular artery (TA2). LK – left kidney. AA – abdominal aorta. IMA – inferior mesenteric artery. LS-RV – left suprarenal vein. GFN – genitofemoral nerve. PM – psoas major muscle. arterial vessels arose from the abdominal aorta. Yet cases concerning the origin of the double left testicular artery from the common trunk with the superior adrenal and the inferior mesenteric artery have been presented [8]. The prevalence of variations upon gonadal arteries was reported to be 16 out of 180 specimens obtained from human fetuses and to be more frequent in men than in women [9]. The variations of the testicular artery could be divided in two groups: (a) variations in the branching level, regarding the vertebral column, or arising locus of the renal arteries (above or below the branching level of the renal arteries) [6] and (b) variation in number, origin, and course; this variation appeared to be more frequent on the right side [9,10]. Also, common origin with the inferior suprarenal artery has been reported [1,8]. Testicular arteries were documented to rise from lumbar, renal, accessory renal, middle, and, occasionally, superior suprarenal arteries [4,7,11]. In a recent case presentation, Paraskevas et al. [12] (2011) described a high origin (above the expected level of branching) of the left testicular artery in a common trunk with the inferior phrenic artery. The bilateral branching of the ovarian arteries from the accessory renal arteries has also been revealed [13]. Most of the variations, includ- ing those described in this paper, have their roots in the embryology of the testes and the contemporaneous blood supply of each phase of development: mesone- phros itself was described to have irrigation from nine mesonephric arteries: superior or cranial, middle, and inferior or caudal (three in each group). The caudal group gives rise to the testicular arteries, whereas the middle forms renal arterial vessels [3]. In our case, both vessels on the left side seemed to originate from the middle group. Double testicular arteries have been obtained in two out of 32 overlooked specimens of human fetuses [14], and both of the testes had an abdominal localization. Whether the arteries supplying undescended testes have variations in number and origin remains unclear, although a different anastomotic network is present in the undescended testicles [15]. A deeper understanding of these variations and their special relationships to adjacent vessels is especially sig- nificant in avoiding sometimes serious complications in clinical operation and other procedures, such as the Fowler-Stephens technique [16], and in recognizing the causes of genital disorders, such as cryptorchidism, and their adequate treatment in order to preserve the func- tionality of the undescended testis. Conclusions Although many kinds of variations of the origin, direc- tion, and pattern of the testicular arteries have been described, this is a rare case of double testicular artery on the left side. Neither of the two branches originated from the abdominal aorta but from the left inferior suprarenal artery and from the left renal artery. The awareness of such variation is important for all surgeons whose interest is related to the testicular blood vessels or, generally, blood vessels of the retroperitoneum. Consent Written informed consent was obtained from the patient’s next of kin for publication of this manuscript