The reported incidence of pancreatitis associated with IDD i

The reported incidence of pancreatitis associated with IDD is <20% and it mainly affects young adults. The pathogenesis of pancreatitis in patients with IDD is not clear. The most widely accepted mechanism is the reflux of the duodenal content through the papilla of Vater. This can be due to pull of the diverticulum neck at the papillary level during duodenal peristalsis and partial obstruction of the duodenum by the distended diverticulum. Our patient would have probably escaped clinical recognition until later in adulthood had she not ingested the coin. It is felt that the presence of the coin could have further contributed to the distention and enlargement of the IDD and subsequently initiated the clinical manifestations of pancreatitis. Although IDD is a rare cause of pancreatitis in children, it should be included in the differential diagnosis. Thus, an upper gastrointestinal study is mandatory for evaluation of anatomic anomalies when other diagnostic tools fail to identify the cause of the pancreatitis in children. As in our case, the pathognomonic radiologic finding of IDD is a wind sock or teardrop appearance of the hesperetin collecting within the duodenal lumen, which was lined by a narrow, radiolucent band. Endoscopy, endoscopic retrograde cholangiopancreatography, magnetic resonance imaging, and CT scanning can also be used to make the diagnosis. Surgical resection, either by open or endoscopic means, is the preferred option for managing symptomatic IDD. In addition to IDD, our patient also had duodenoduodenal intussusception, which is a very rare complication because the duodenum is fixed in the retroperitoneum. It usually occurs secondary to a neoplasm that acts as a lead point. Griffin et al described an IDD that had migrated beyond the ligament of Treitz causing intussusceptions at the distal portion of the duodenum. They found that distention of the diverticulum led to subsequent intussusception that caused duodenal obstructions in their case. Intussusception in our patient occurred at the second portion of the duodenum, which is exceptionally rare. It is debatable whether intussusception is secondary to IDD per se or the duodenal polyp. Because the polyp was situated proximally to the orifice of IDD, the peristaltic waves would have reached the polyp earlier. As a result, it is more likely that the polyp had acted as a lead point for mucosal enveloping.
Introduction Transverse testicular ectopia (TTE), also known as testicular pseudoduplication, unilateral double testes, transverse aberrant testicular maldescent, and crossed testicular ectopia, is a rare form of testicular ectopia with an unclear etiology. In patients with this disorder, both testes migrate towards the same hemiscrotum, leaving an empty hemiscrotum on the other side. Patients reported in the literature typically presented with uniform symptoms of an inguinal hernia on one side and an impalpable testis on the other side, and most patients underwent operations prior to receiving a definite diagnosis. This report describes three cases of TTE with variant presentations.
Case report In the past 3 years, three boys, aged 6 months, 7 months, and 6 years, were brought to our pediatric surgery clinic with impalpable testes found since birth on the left, left, and right sides, respectively. No family history of the disorder or remarkable birth history was noted in any of the patients. Physical examination revealed two testes in the contralateral hemiscrotum and the absence of a testis on one side. Figs. 1–3 show capillary hemangiomas present on the surface of the empty hypoplastic hemiscrota in all patients. Abdominal computed tomography showed no evidence of urinary system abnormalities or rudimentary Müllerian duct structures (uterus, fallopian tube, and ovary). The operative procedure included trans-septal delivery of the more distal testis to the empty side and orchiopexy in the subdartos pouch (Fig. 4). One-year follow-up revealed no testicular atrophy, hernia, or resolution of the hemangiomas in all patients.