transverse testicular ectopia ( tte ) is an uncommon anatomical abnormality in which both the gonads migrate towards the same hemiscrotum .
the ectopic testis may lie in the opposite hemiscrotum , in the inguinal canal or at the deep inguinal ring .
an inguinal hernia is commonly present on the side to which the ectopic testis has migrated .
we present a case of 42-year - old male diagnosed preoperatively as left inguinal hernia with normal ultrasonography findings , who found to have tte on exploration .
a 42-year - old married male , having three children , presented to us with history of swelling over left inguinal region for 2 years .
the swelling was painless , gradually increasing in size and more prominent on coughing and straining .
he was planned for hernioplasty and on exploration , there was a left indirect inguinal hernia with thinned out hernial sac with vas and cord structures of the left side .
surprisingly , both testes could be delivered into the wound with their individual vas deferens and cord structures ( fig .  1 ) .
both of them were mobilized , followed by right orchidopexy ( of medially located testis ) by passing it through a trans - septal incision .
he had an uneventful recovery and on follow - up , he had no complications ; both the testes were normal to feel with no vascular compromise on doppler study .
figure  1:exploration of left inguinal region revealed both testes with cord structures on the left side .
exploration of left inguinal region revealed both testes with cord structures on the left side .
tte , also called testicular pseudoduplication , unilateral double testis and transverse aberrant testicular maldescent , is an uncommon anatomical abnormality in which both the gonads migrate towards the same hemiscrotum .
adhesion or fusion of developing wolffian ducts , defective or aberrant gubernaculum , testicular adhesion , defective formation of the internal inguinal ring , traction on a testis by persistent mllerian structures and possibility of the development of both testes from the same germinal ridge , are some of the postulated theories for the ectopic testis .
mechanical effect of persistent mllerian duct structures may prevent the testicular descent or lead to both testicles descending towards the same hemiscrotum , producing tte .
tte may have an increased risk of malignancy as any other forms of ectopic testis or undescended testis , so long - term follow - up is required .
tte is classified into three types based on associated abnormalities : 
 type i : accompanied only by hernia ( 4050%).type ii : accompanied by persistent or rudimentary mllerian duct structures ( 30%).type iii : associated with disorders other than mllerian remnants , e.g. hypospadias , true or pseudohermaphroditism and other scrotal abnormalities ( 20% ) .
type iii : associated with disorders other than mllerian remnants , e.g. hypospadias , true or pseudohermaphroditism and other scrotal abnormalities ( 20% ) .
patients with tte commonly present as inguinal hernia on one side and absent testis on the other side .
the patient had left inguinal hernia and absent testis on the right hemiscrotum , which we could not identify on clinical examination and ultrasonography .
one explanation could be that since both the testes were on the left hemiscrotum , the pressure effect of left testis on right one could have pushed the right testis towards further right of the left hemiscrotum giving a false impression on clinical examination that location of right testis was on correct side .
there are reports suggesting ultrasonography , ct scan , magnetic resonance imaging and magnetic resonance venography as tools for preoperative diagnosis of tte .
the case presented here was managed by orchidopexy of the correctly lateralized testis to the ipsilateral hemiscrotum , and orchidopexy of the crossed testis to the contralateral hemiscrotum through a trans - septal incision , known as the ombredanne procedure .
this case is reported with a view that surgeons need to be aware of this anomaly during repair of inguinal hernia , as most cases of tte are diagnosed intraoperatively , hence adequately and safely treat the patient even with tte when discovered unexpectedly , continue long - term follow - up to identify malignancy early , if any .
patients with tte need to be treated by restoring the contralateral testis to its original hemiscrotum through a trans - septal incision .
written informed consent was obtained from the patient for publication of this case report and related photograph .
all three authors were involved in the treatment of the patient and wrote and finalized the manuscript .
 transverse testicular ectopia ( tte ) is a rare anomaly that is commonly associated with inguinal hernia . 
 most of the reported cases are in children with very few reported cases in adults . 
 we report a case of 42 years , fertile male , who presented with left reducible inguinal hernia . during surgery 
 , he was found to have a left indirect inguinal hernia with tte with both testes on the left side . 
 hernioplasty and bilateral orchidopexy were performed . 
 he had an uneventful recovery . 
 most of these cases are diagnosed intraoperatively , but imaging ( ultrasonography and magnetic resonance imaging ) has emerged as a promising tool for preoperative diagnosis although ultrasound missed it in this case . 