Continuous splenogonadal fusion in a pediatric patient with bilateral cryptorchidism: A case report

Introduction: Splenogonadal fusion (SGF) is a rare condition characterized by abnormal fusion of splenic and gonadal tissue with fewer than 200 cases reported in the literature. While ipsilateral cryptorchidism is an established association in males, bilateral cryptorchidism is exceptionally rare with only a handful of documented cases. Case Report: A 5-week-old male infant was evaluated and followed in clinic for bilateral undescended testes with the right testis initially being palpable and the left testis being nonpalpable. Later both testes were found to be nonpalpable. Diagnostic laparoscopy at ten months of age revealed a healthy intra-abdominal right testis and an abnormal left intra-abdominal testis attached to an elongated tail of the spleen extending into the pelvis, consistent with continuous SGF. Given the abnormal appearance of the left gonad and the importance of preserving at least one functional testis, a first-stage laparoscopic Fowler–Stephens orchidopexy was performed on the right and definitive management of the left testis was deferred. At a second operation five months later, the right testis remained viable and was successfully brought into the scrotum. After freeing the left testis from the spleen, the testis lacked spermatic vessels and vas and was found to have limited mobility despite extensive dissection. Because the testis could not be positioned within the scrotum, a left orchiectomy was performed. The pathology demonstrated an immature testis with a predominantly Sertoli cell pattern. Conclusion: Splenogonadal fusion is a rare condition associated with cryptorchidism. Bilateral cryptorchidism associated with SGF is exceedingly rare and may reflect a broader developmental anomaly beyond simple mechanical tethering.