Splenogonadal fusion: A rare case report and literature review

Continuous Splenogonadal Fusion Diagnosed by Laparoscopy in a Child With a Communicating Hydrocele

Splenogonadal fusion is a rare congenital anomaly primarily affecting males, characterized by an abnormal fusion of the spleen and the gonad. There are two primary forms: continuous, in which the normal spleen is directly connected to the gonad via a cord of fibrous or splenic tissue, or a combination of both, and discontinuous, in which ectopic splenic tissue fuses to the gonad without connection to the normal spleen. Continuous splenogonadal fusion is often associated with other congenital defects, such as cryptorchidism, limb anomalies, and micrognathia. Due to its rarity and nonspecific symptoms, splenogonadal fusion is typically diagnosed incidentally during surgery for undescended testis or inguinal hernia. We present a case of a five-year-old boy with a communicating hydrocele who underwent surgical repair. Intraoperative findings during inguinal exploration revealed a fibrous connection to the upper pole of the left testicle, extending into the internal inguinal ring. Diagnostic laparoscopy confirmed continuous splenogonadal fusion, demonstrating splenic tissue and a fibrous cord with islands of splenic tissue extending from the spleen to the internal inguinal ring. A portion of the fibrous cord with splenic nodules was excised and examined pathologically, confirming the diagnosis of splenogonadal fusion. The diagnosis of continuous splenogonadal fusion primarily relies on intraoperative findings during surgery for other conditions. Laparoscopy can be instrumental in diagnosing this rare condition.

Splenogonadal fusion- a great clinical masquerader: a case report and review of literature

Background

Splenogonadal fusion (SGF) is a rare developmental choristoma in which ectopic splenic tissue is aberrantly attached to the gonads, mostly in the scrotum. It is a great clinical masquerader, and accurate preoperative diagnosis is often difficult due to the rarity of this entity. Many patients tend to undergo unnecessary surgical explorations and also orchiectomy. Accordingly, this article aims to review the latest literature regarding SGF and a description of the radiological features of this rare entity. Multiple systematic methods were used to find the latest publications on splenogonadal fusion by searching the Scopus, PubMed, and Google Scholar databases online since 2013. The latest comprehensive review of this rare entity was of 61 cases by Malik et al. in 2013. We reviewed all the cases of SGF reported in the literature in the last 10 years between 2013 and 2022 with an emphasis on diverse clinical presentations and radiologic findings. Along with this, a surgical and pathological proved case of SGF will be presented with emphasis on imaging findings. Splenogondal fusion is an uncommon differential diagnosis in patients with scrotal swelling. The current literature review showed the discontinuous type (63%) of SGF to be more common than the continuous (37%) type in contradiction to the previous literature review. Orchiectomy was done in 36% of cases as compared to 24% as described in the latest review by Malik et al.

Conclusions

Knowledge of this entity along with familiarization with its imaging features among radiologists is essential for surgical prognostication and avoiding unnecessary orchiectomy. We suggest that the addition of colour Doppler and elastography to routine grey-scale ultrasound can increase diagnostic confidence. Subsequent cross-sectional imaging with magnetic resonance imaging (MRI) helps categorize the subtype and pre-operative planning.

Splenogonadal fusion: A case series of two challenging diagnoses

Splenogonadal fusion is an abnormal connection between the spleen and gonads. This rare entity can be easily confused with testicular tumors. It usually accompanies congenital malformations, such as cryptorchidism, making diagnosis more difficult. Surgeons must be aware of this entity to avoid unnecessary orchiectomy. In some cases, biopsy may help with diagnosis.