article · International Journal of Surgery Case Reports
Cryptorchidism, or undescended testis, is a common congenital condition of the male urinary and reproductive systems. Anatomical anomalies within the spermatic cord can elevate the danger of accidental surgical injury during corrective surgery, known as orchidopexy. In a documented case involving a seventeen-year-old patient with lifelong undescended testis on one side, an extraordinarily long loop of the vas deferens measuring approximately twenty centimetres was encountered. Because such redundant loops can mimic duplicated tissues or fibrous bands, they carry a high risk of being mistakenly cut, which could result in obstructive azoospermia. Systematic tracing and careful dissection enabled the complete preservation of the vas deferens, and the testis was successfully repositioned into the scrotum with a stable outcome at six months. This finding highlights the need for careful anatomical identification during delayed surgical interventions.
Undiagnosed or late-treated undescended testes carry risks of surgical complications that could permanently impair male fertility. Surgical misidentification of unusual reproductive duct structures can lead to accidental severance and subsequent blockages. Recognising these anatomical variations helps surgeons exercise appropriate caution during late interventions, ensuring that patients retain fertility and experience successful long-term surgical outcomes.
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Introduction and importance: Cryptorchidism is one of the most common congenital anomalies of the male genitourinary tract. Anatomical variations of the spermatic cord structures, though underreported, may increase the risk of iatrogenic injury during orchidopexy. Case presentation: A 17-year-old male presented with lifelong unilateral cryptorchidism. Preoperative ultrasonography localized the testis in a high inguinal position with preserved vascular flow. Given the patient's informed refusal of orchiectomy despite counseling on malignancy risk, elective orchidopexy was performed. During surgery, an unusually long, redundant vas deferens loop measuring approximately 20 cm was identified. Through systematic proximal-to-distal tracing of the vas deferens and meticulous mobilization of the entire redundant segment, the structure was fully preserved. The testis was fixed in a tension-free subdartos pouch. Postoperative recovery was uneventful, with confirmed scrotal position at the 6-month follow-up. Conclusion: This case highlights a rare but surgically significant anatomical variant that may simulate a fibrous band or a duplicated structure and may be inadvertently divided during orchidopexy. Full identification of the cords' contents before dissection of the cords is critical to avoid obstructive azoospermia. Surgeons should maintain heightened vigilance for ductal anomalies, particularly in older patients with prolonged cryptorchidism, in whom anatomical distortion is more likely.
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DOI: 10.1097/rc9.0000000000000833
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