Transverse testicular ectopia presenting as an inguinal hernia in a 2-year-old child: Case report.

Background: Transverse testicular ectopia (TTE) is a rare congenital anomaly where both testes migrate into a single inguinal canal, often mimicking a routine inguinal hernia. This condition is frequently overlooked in low-middle-income countries (LMICs) due to diagnostic limitations, increasing risks of complications such as infertility or malignancy.

Methods: A 2-year-old male from an LMIC presented with a right inguinal swelling and an impalpable left testis. Clinical evaluation suggested a typical inguinal hernia, but suspicion for TTE arose due to contralateral cryptorchidism. Limited access to advanced imaging precluded preoperative confirmation. Intraoperative exploration revealed both testes, vas deferens, and epididymis within the hernia sac, confirming TTE.

Conclusions: TTE is seldom diagnosed preoperatively in resource-constrained settings, where imaging modalities like MRI or laparoscopy are often unavailable. Surgical exploration remains the gold standard for definitive diagnosis and management. In this case, bilateral orchidopexy and hernia repair were performed, emphasizing the importance of early intervention to mitigate long-term risks. The diagnostic challenges in LMICs underscore the need for heightened clinical suspicion in cases of pediatric inguinal hernia with cryptorchidism. Conclusions: This case highlights TTE as a critical differential diagnosis for pediatric inguinal hernias associated with undescended testes, particularly in LMICs. Surgeons must prioritize intraoperative exploration when imaging is inaccessible to ensure timely management. Awareness of this rare anomaly and tailored surgical strategies are essential to optimize outcomes in resource-limited contexts.