OF THE VAS DEFERENS*
EMILE BLOCH, M.D. AND W.
New Orleans, Louisiana
HE reported congenital anomahes of the testis are few in number and dea1 mainIy with faiIure of union between the epi&dymis and the testis. Reference is made to Badenoch’ and Brunzema2 who found it four times in 104 cases of undescended testis.
non-contributory. He was the father of one chiId now thirty years old. Physical examination reveaIed the folIowing vital signs: bIood pressure 120/70, puIse 80, respirations 20, temperature 98.6”~. PhysicaI findings were within normal limits except
AYTLRIOR SURFACE 5CKOTl.l~
WJTCIRmK SuRFaCE SClOTlW
t,w,rv Tu*lc* "*GIN*‘,S_--___ 7W1‘I) ALBUGINLA--------TESTIS_-_-.---
FIG. I. Diagram
----_----_-----_----TUNI‘R"A‘,"~~Y,* wo PmRpIUJ --------------LAYtLS IY_MTX F&O,+ --------------*"*~RF,L.~EL,*~I)L~~,~ nLnIc* DA.LW.5 _--_--____----___*#.,a
of anomaly of vas deferens.
Kaufman3 and WindhoIz4 mentioned a complete separation of the epididymis and testis. Wilsonj recorded one case in which the testis was in the inguinal canal and the epididymis was in the scrotum. 0mbredanne6 described separations occurring occasionaIIy when there was a vestigial testis. Wangensteen? quoted a case of an epididymis with a vestigia1 structure attached to it which had none of the appearance of the testis. Hobday8 mentioned that in the horse the epididymis is occasionaIIy found in the inguina1 cana whiIe the testis is in the abdomen. The case we wish to report represents a type of congenita1 anomaly which has not been reported in the Iiterature, so far as we couId ascertain. (Fig. I.) CASE
Mr. H. P. C., age fifty-seven, was admitted to the Touro Infirmary (No. 10627-50) on August 16, 1950, with a twenty-year history of a hernia of inguinal-scrota1 type which had never incapacitated him in any way, including outdoor sports. Past history was * From the SurgicaI Department,
for the presence of a Iarge right inguinalscrotal hernia which was easily reduced. Laboratory data including complete blood count, urine, chemistry and serology were normaI. Surgical procedure was as fohows: An incision was made in the skin parahel to the ilioinguina1 Iigament and carried through external After opening the inobIique aponeurosis. guinal canal, the entire hernia1 mass was brought into the wound. As the hernia was thought to be of congenita1 type, the sac was opened with the idea of creating a proximal and a dista1 sac from within. The proximal sac was isolated and a purse-string suture placed from within the sac and reinforced by a transfixing ligature to obliterate the internal opening. In attempting to isoIate the vas deferens in the dista1 sac it was found that the vas ended in rete fashion into the inferior portion of the tunica vaginaIis and was accompanied by a large vein. The spermatic cord was identified. The cremasteric muscle fibers and infundibuliform fascia were separated and the cord was found to contain no Touro
New Orleans, La.
vas deferens. AI1 other spermatic structures, the testicIe and epididymis were intact. At operation, with the idea of preventing a postoperative hydrocele and obtaining a more secure hernioplasty, an orchidectomy with removal of the cord was done. The pathoIogist’s report confirms the fact that the vas deferens did not communicate with the epididymis. In repair of the inguinal canal the transversalis fascia was approximated to the ilioinguinal ligament with interrupted cotton The external obIique aponeurosis sutures. was reapproximated with interrupted sutures; the superficial fat and fascia closed with interrupted catgut sutures; the skin was cIosed with Nlichel cIips. Postoperative course was uneventful. COMMENTS
In an attempt to explain the anatomic defect, standard textbooks on embrvoIogy were of no avaiL We could find no &miIar cases in the literature. In reviewing the embryoIogy of the genita1 tract one finds the following: The mesonephron forms a strong projection into the body cavity from the posterior waI1 of the abdomen. On the media1 surface of the peritoneum, which covers it, a thickening appears which is termed the genital ridge. The upper part of the ridge becomes the whiIe the remainder becomes the testis, gubernaculum. As the testis develops, the upper part of the Wolffran body (mesonephron) enters in reIation with the testis and direct union with the seminiferous tubules. The WoIffran body then divides into a reproductive and excretory portion; when the metanephron (permanent kidney) develops, the excretory portion of the WoIfian body degenerates, Ieaving a few tubules as the vas aberrans and paradidymis. The reproductive portion forms the tubules of the epididymis and serves to transport the spermatozoa to the WoIffran
duct. The WoIffran duct oersists (in the maIe) to form the vas deferens of which the semina1 vesicIe is an out pouching and the ejacuIatory duct a continuation. The explanation of this reported anomaly seems to Iie in the simiIaritv ., in the deveIooment between the gastrointestinal tract and the Wolffian duct. Both begin as a solid structure which becomes tubuIar, Iater soIid, and finaIIy tubular again. It is well known that one mav find two bIind ends of smaI1 bowel with no evidence of connection. This is exDIainabIe on the basis of an area of atresia ‘forming a narrow band connecting the two segments of bowel. As the infant grows the weight of intestine is of sufficient distracting force to tear this cord in two. We beIieve that a simiIar area of atresia occurred in the WoIffran duct of this patient and that the forces involved in the descent of the testicle were sufficient to cause a compIete severance of the atresic portion of the vas deferens, resulting. in a vas deferens which did not commuiicate with the epididymis. 1
I. BADENOCH, A. W. 2.
5. 6. 7. 8.
Failure of the urogenital union. Surg., Gynec.
1929. Cited by Badenoch.’ Quoted by Brunzema.2 Cited by Baden0ch.l WINDHOLZ. Chirurgie des Hodens und des Samenstranges. Neue Deutsche Chirurgie. Stuttgart, 1926. Cited by Badenoch.’ WILSOX, D. S. P. Treatment of incompIetely descended testis. Proc. Roy. Sot. Med., 32: 969-986, 1939. Cited by Badenoch.’ OMBKEDANNE, L. Chirurgic Infantile. Paris, 1923. Masson et Cie. Cited by Badenoch.’ WANGENSTEES, 0. H. Surgery of undescendcd testis. Surg., Gynec, (‘V 0bst.T 5i: 219-231, 1932. I IOBDAY, F. T. G. Castration and Ovariotomy. Edinburgh, ryr4. W. and A. K. Johnston. Cited by Baden0ch.l KAUFMAN.