Pediatric Case Report Congenital Spigelian Hernia and Ipsilateral Cryptorchidism: Raising Awareness Among Urologists Zarine R. Balsara, Abigail E. Martin, John S. Wiener, Jonathan C. Routh, and Sherry S. Ross Spigelian hernias (SHs) are rare in the pediatric population. Although pediatric general surgeons often treat this defect, the increased association between a congenital SH and an ipsilateral undescended testis suggests that urologists may be the first provider encountering this entity. Knowledge of this condition is therefore important. We report one such case of a male infant referred to urology for an undescended testicle. Further investigation revealed the testicle to be within a congenital SH sac. Herein, we additionally review the literature concerning SHs associated with ipsilateral unde- scended testicles. UROLOGY 83: 457e459, 2014. Ó 2014 Elsevier Inc. C ongenital spigelian hernias (SHs) are exceed- ingly rare. As the name implies, the defect occurs through the spigelian fascia, a section of the transversus aponeurosis located between the lateral border of the rectus abdominus muscle and the semilunar line. 1 The most common location of an SH is inferior to the arcuate line where the posterior rectus fascia is defi- cient. Reported contents of congenital SH include extraperitoneal fat, peritoneum, small intestine, sigmoid colon, and testicles. 2 Herein, we report on a 3-month-old boy with an undescended testicle located within a congenital SH sac. Diagnosis was initially suggested on abdominal ultrasound and confirmed on exploratory laparoscopy. This report lends further credence to the argument that ipsilateral cryptorchidism and SH together represent a distinct clinical association. CASE REPORT A full-term male infant with normal prenatal ultrasound was referred to urology at 2 weeks of age for evaluation of a nonpalpable left testicle. The parents also reported a palpable bulge of the baby’s left lower abdominal wall with crying and straining. There was no associated nausea, vomiting, anorexia, or pain. On examination, the left hemiscrotum was hypoplastic and there was no palpable testicle in the scrotum or inguinal canal. In the inferolateral aspect of the left lower abdominal wall just above the inguinal canal, there was a small bulging area that was easily compressible and nontender to palpation, consistent with an abdominal wall hernia. Over the next month, the ventral wall hernia increased in size but Figure 1. Abdominal ultrasound revealed a normal-sized left testicle (white arrowhead) within the spigelian hernia sac in the left lower quadrant with loops of bowel (white arrows) surrounding the testicle. (A) Left lower abdomen transverse scan. (B) Left parasagittal longitudinal scan. Financial Disclosure: The authors declare that they have no relevant financial interests. From the Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC; the Department of Pediatrics, Duke University Medical Center, Durham, NC; the Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; and the Division of Abdominal Transplant Surgery, Department of Surgery, Duke University Medical Center, Durham, NC Reprint requests: Sherry S. Ross, M.D., Departments of Surgery and Pediatrics, Division of Urology, Duke University School of Medicine, Box 3831, Durham, NC 27710. E-mail: sherry.ross@duke.edu Submitted: July 15, 2013, accepted (with revisions): September 27, 2013 ª 2014 Elsevier Inc. 0090-4295/14/$36.00 457 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2013.09.032