The Transverse Testicular Ectopia Presenting as Primary Infertility in Adulthood

Background Transverse testicular ectopia (TTE), also known as crossed testicular ectopia, is a rare congenital anomaly in which both testes migrate to the same side of the body. TTE is typically diagnosed during the childhood; however, on rare occasions, it may present or be identified in adulthood. Case presentation We report a case of a 35-year-old male, married for three years, who presented with primary infertility. Clinical examination revealed an empty scrotum, with neither testis palpable in the scrotum nor the inguinal canals. Semen analysis revealed azoospermia. Ultrasonography demonstrated the presence of both testes in the right iliac fossa in relation to the external iliac vessels, and the diagnosis was subsequently confirmed on magnetic resonance imaging (MRI). Although most cases of TTE are associated with additional anomalies—most commonly inguinal hernia—our patient had no associated anomalies which may have contributed to the late presentation in adulthood, as medical attention for undescended testes was not sought earlier by the patient. Conclusions TTE is an uncommon condition and is most frequently diagnosed in childhood. Presentation in adulthood with infertility is exceptionally rare. This case highlights a delayed presentation of TTE with infertility. This case report further emphasizes the role of ultrasound and MRI in establishing an accurate preoperative diagnosis.