Case of Testis in Perinaeo, Complicated with Congenital Inguinal Hernia and Acute Orchitis
Authors: J. Alex. Williams
Journal: BMJ (1883)

Late House-Surgeon to the Royal Portsmouth Hospital.THE rare and interesting form of congenital malposition of the tes- ticle into the perineum is less common than its simple retention within the abdomen; but, from its exposed position in this situation, the resulting symptoms are much more severe,Land operative inter- ference is more frequently required.According to Curling (Diseases of the Testis, p. 51), it appears to be occasioned by an abnormal attachment of the middle portion of the gubernaculum testis to the perinlum.An analysis of 25 cases in which this malposition has been ob- served shows that, in the majority of cases, the scrotum is sym- metrically developed.In only 6 of the above cases (2 recorded by Curling, 3 by Bryant, and 1 by Baudry) was any maldevelopment observed; and the major portion of these were adults, in whom the atrophy was not congenital, but resulted simply from disuse of the scrotal pouch upon the side involved.The displacement is more frequently observed in connection with the right (17 cases) than with the left testicle (8 cases).In only 3 cases, including that now recorded, was it associated with hernia, the other examples of this complication having been observed by Godard and Bryant respectively.The present case is the only instance, so far as I am aware, in which it was further complicated by hydrocele.A double dis- placement has been observed by Mr. Hutchinson.It would ap- pear that retained testicles are prone to become the seat of malignant disease; many such cases have been recorded.From analogy we might reasonably infer, that testicles misplaced into the perinaeum, from their greater exposure to external injuries, would be especially liable to that disease.There are, however, no recorded cases of malignant disease attacking a testicle so misplaced.In answer to a question on this subject, Mr. Bryant has kindly expressed himself as follows." I have never seen a testicle in the perinocum become the seat of cancer.Such testes are usually better developed than the undescended, which are usually ill developed as well as misplaced, and, under such circumstances they are probably less prone to disease than the undescended I am likewise unable to give you any reference to such a case."According to Mr. Curling (Diseases of tle Testis, p. 434,) a mal- placed testicle is incapable of secreting spermatozoa; hence " a male with this defect on both sides, though often potent and efficient for sexual intercourse, is incapable of impregnating the female," and is consequently sterile.The same is true if disorganising disease at- tacks the normally placed testicle.Spermatozoa have never been found in the semen ejaculated during coitus in such cases.The only recorded case in which a misplaced testicle has been shewn to secrete spermatozoa was met with by Mr. Ledwich in the dissecting-room.In this case the right testicle was misplaced into the perinseum, and its ducts contained spermatozoa.The misplaced testicle being, in the great majority of cases, freely mobile in the perinaeum, injurious pressure can, in most cases, be avoided by sup- porting the gland, by means of a truss or bandages, in the groin.Should, however, the gland become fixed in such a position that injurious pressure is unavoidable, it had better be excised, or an attempt made to replace it in the scrotum.With this object, numerous operations have been performed, but of these there are only recorded two successes.Mr. Annandale, with antiseptic pre- cautions, successfully replaced the right testicle into the scrotum in a child 3 years of age; and Mr. John Wood has successfully per- formed a subcutaneous operation, in which the gland, having been freed from its perineal adhesions, was replaced in the scrotum and retained there by means of a hare-lip pin.(Quavin's Dictionary qf Medicine, p. 1607.)In many instances, the operation has proved fatal.In Mr. Adams's (Lancet, vol.i, 1871, p., 710) case, erysipelas was contracted, and the patient died of peritonitis.At the necropsy, * Bead before the Staffordshire Branch.