Complete urogenital nonunion ☆ Ayşe Karaman ⁎ , İbrahim Karaman, Engin Yılmaz, Beytullah Yağız, İsmet Faruk Özgüner Department of Pediatric Surgery, Dr Sami Ulus Children's Hospital, 06080 Altındağ/Ankara/Turkey Received 6 June 2011; revised 23 August 2011; accepted 23 August 2011 Key words: Undescended testis; Epididymal anomalies; Nonunion; Orchidopexy; Child Abstract A 7.5-year-old boy was admitted to our department with left undescended testis. On surgical exploration, the vas deferens and epididymis were normal in appearance in its route to the scrotum, but no obvious testis or testis-like structure was identified. Exploration was extended to the abdominal cavity via the processus vaginalis, and the testis was found near the sigmoid colon without any connection to the vas deferens and epididymis. The testis was freed from surrounding structures preserving the testicular vasculature, and an orchidopexy was performed. In cases of nonpalpable testis with the vas deferens and epididymis reaching to the scrotum, an intra-abdominal testis owing to a nonunion phenomenon must be considered, and extended exploration should be performed. © 2011 Elsevier Inc. All rights reserved. Complete urogenital nonunion (absence of fusion) is a very rare anomaly [1-3]. Here, we present a case to emphasize the importance of exploring for an intra-abdominal testis during surgery for an undescended testis even when the vas deferens and epididymis are located in the scrotum. 1. Case report An otherwise healthy 7.5-year-old boy was admitted to our department for an undescended left testis. On physical examination, the right testis appeared normal in size and was located in the scrotum. The left testis was not palpable with a small mass compatible with a testicular nubbin that was noticed in scrotum. On ultrasound imaging, a testis-like structure was identified proximal to the internal inguinal ring, which was measured 15 × 12 × 6 mm in size. Surgical exploration revealed a normal vas deferens with a normal course within the left inguinal canal and a normally located epididymis in the scrotum. Exploration was extended to the abdominal cavity through the processus vaginalis, and the testis was found near the sigmoid colon with no obvious connection to the vas deferens and epididymis (Fig. 1). The testis was freed from surrounding structures preserving the testicular vasculature and an orchidopexy performed placing it in the scrotum. The postoperative course was uneventful. 2. Discussion The testis and epididymis are derived from different embryological structures. During the sixth week of gestation, the primordial germ cells migrate to the genital tubercle from ☆ This case was presented in 2nd Annual Congress of the Society for Pediatric Urology, May 16, to 19, 2011, Istanbul, Turkey. ⁎ Corresponding author. Fax: +90 312 317 03 53. E-mail address: ayseuk@gmail.com (A. Karaman). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2011.08.015 Journal of Pediatric Surgery (2011) 46, E17–E18