Congenital Spigelian Hernia With Ipsilateral Ectopic Testis.

The association between congenital spigelian hernia and ipsilateral ectopic testis has been debated in the literature, and the management of such cases has yet to be standardized. Both pediatric surgeons and sonographers should be aware of this entity to allow for prompt diagnosis and monitoring/repair because congenital spigelian hernias have a high risk of incarceration. A 3-month-old male presented with left-sided abdominal wall swelling present since birth with coexisting left-sided undescended testis. Ultrasound confirmed the suspicion of a congenital spigelian hernia with undescended testis but failed to locate the ectopic testis. Diagnostic laparoscopy and open repair of the spigelian hernia were performed when the patient was 9 months of age. Left-sided orchidopexy was also performed as the left testis was located within the spigelian sac. The patient was asymptomatic at 1-year follow-up. The association between congenital spigelian hernia and ipsilateral ectopic testis requires the surgeon and sonographer to pay special attention to the spigelian hernia sac as it may contain the ectopic testis. Orchidopexy and hernia repair in very young children may be delayed while closely monitoring for incarceration to allow for improvement in immunity, an increase in size of the spermatic cord and vasculature, and avoidance of the stress of 2 separate surgeries. The surgical approach can be laparoscopic or open depending on the experience of the surgeon and the complexity of intraoperative findings.