case_images: PMC10794592_01
case_images: Appearance of case 1 and intraoperative findings. Physical examination showed bilateral impalpable testes and coronal hypospadias (A). Preoperative ultrasound suggested that the left testis was adjacent to the lower pole of the spleen (B). The left testis was fused to the spleen (C), and the right testis was located in a flat umbilical position at the lower edge of the liver (D) (Black triangle: left testis; black arrow: spleen; white arrow: left testis; black star: right testis; white star: liver.)
case_images: fped-11-1269879-g001.jpg
case_images: PMC10794592_01_fped-11-1269879-g001.jpg
case_images: F1
case_images: Physical examination revealed bilateral impalpable testes and coronal hypospadias (Figure 1A). Preoperative ultrasound suggested bilateral intra-abdominal cryptorchidism, with the left testis positioned adjacent to the lower pole of the spleen (Figure 1B). Laparoscopic exploration revealed that both internal rings were closed, the left testis was fused with the spleen, and the diagnosis was continuous SGF (Figure 1C). The right testis was located in a flat umbilical position (Figure 1D), the gubernacular cord and vas deferens were thinly vascularized, and there was a possibility of bilateral testicular atrophy; furthermore, the urethra needed an additional operation for repair.
case_images: PMC10794592_02
case_images: Pre-operative ultrasound and post-operative ultrasound of case 2 US examination of the left testis, it indicated the left testis was adjacent to the lower pole of the spleen (A). 1 month after surgery, the left testis was well positioned and survived (B). (Black triangle: spleen, white triangle: left testis).
case_images: fped-11-1269879-g002.jpg
case_images: PMC10794592_02_fped-11-1269879-g002.jpg
case_images: F2
case_images: Preoperative ultrasound suggested that the boy had SGF on the left side (Figure 2A). After confirmation of the viability of the left testicle (Figure 2B), the boy underwent another single-stage FSO to bring the right testicle down into the scrotum.
case_images: PMC10794592_03
case_images: The appearance of case 3 and intraoperative findings On palpation of the scrotum, there was a firm mass located in the upper pole of the left testis (A). MR showed a cordlike structure extending from the upper pole of the mass to the abdominal cavity (D). The cord was ligated at a high position, and a transverse incision was taken in the left scrotum (C). The left testis and the connected splenic cord were pulled out completely (B), and the accessory spleen was removed and the testis was preserved. (White dotted circle: splenic cord, black triangle: left testis, white triangle: spleen)
case_images: fped-11-1269879-g003.jpg
case_images: PMC10794592_03_fped-11-1269879-g003.jpg
case_images: F3
case_images: Physical examination suggested that, in addition to the cord-like mass in the upper pole of the left testis, a small amount of fluid could be found around the gonad (Figure 3A). During the examination, the radiologist found that the upper edge of the lesion entered the pelvic cavity along the left groin and eventually connected with the spleen (Figure 3D). A high ligation of the cord was performed, followed by a transverse incision in the left scrotum (Figure 3B). The left testis and the attached splenic cord were fully extracted, and the accessory spleen was removed while preserving the testis (Figure 3C).