Isolated unilateral duplication of vas deferens, a surgical enigma: a case report and review of the literature
© Chintamani et al; licensee BioMed Central Ltd. 2009
Received: 23 September 2009
Accepted: 26 October 2009
Published: 26 October 2009
Duplication of vas deferens is a very rare congenital anomaly with only a few cases reported in the literature. Injury to vas deferens is a recognized complication during hernia surgery and the possibilities of injury may increase with lack of awareness of this anomaly.
A-31-year old gentleman with unilateral duplication of vas deferens that was diagnosed during right sided open hernia surgery is reported. The patient had undergone surgery for left inguinal hernia one year previously at the same center and no such anomaly was detected. During intra-operative examination of scrotum, the testes and epididymis were found to be normal. Patient had an uneventful recovery from hernia surgery.
Unilateral duplication of vas deferens is rare. The identification of this anomaly is essential in order to minimize the incidence of injury to vas during hernia surgery. This case reinforces the importance of routine identification of vas deferens and awareness about this anomaly during inguinal hernia surgery.
Duplication of vas deferens(VD) is rare with only a few cases reported in the world literature [1–6]. A large number of hernia surgeries are performed world over, annually and injury to VD is a recognized complication of this surgery. Identification of VD during dissection of the hernia sac is therefore considered mandatory. The chances of iatrogenic injury to the vas are increased if this anomaly is not detected making it essential for a surgeon to be aware of this anomaly. The anomaly is usually associated with unilateral renal agenesis and other renal anomalies [3–5].
A 31-year-old man was worked up for a symptomatic, reducible right inguinal hernia. There were no urinary or abdominal symptoms. His history was significant only for an uneventful, left open inguinal hernia repair one year previously at our center. No duplication of vas deferens or any other anomaly was observed. On examination, the patient had an easily reducible, moderate-sized, right inguinal hernia with normal testes. Ultrasound examination of the abdomen and pelvis did not reveal any abnormality.
Duplication of vas deferens is a rare congenital anomaly for which the overall incidence in the general population is estimated to be less than 0.05% [2–4]. About 1% of boys have an absent vas, which may be accompanied by renal agenesis. Abnormalities of the vas deferens and ureter are explained embryologically using the concept of the proximal vas precursor (PVP). The PVP is the segment along mesonephric duct that occupies an intermediate position between the upper and common mesonephric ducts(CMD). It differentiates in to the vas deferens and seminal vesicles. The more caudal CMD forms a ureteral bud that will grow to contact the metanephric blastema resulting in the kidney and collecting system. Reported cases of so-called double vas or true duplication of vas involve renal dysgenesis and an ectopic ureter simulating a double vas [2–4]. Duplication of the PVP presumably gives rise to partial duplication of the vas deferens at the level of the inguinal canal .
Unilateral duplication of vas deferens is rare and may predispose to Injury to the vas deferens during hernia surgery [1–8]. A duplicated vas deferens may be associated with other congenital abnormalities such as ipsilateral renal agenesis and cystic fibrosis[6, 7]. Anomalies of vas deferens can be categorized as absence, duplication, ectopia, hypoplasia and diverticulum.
Injury to the vas is a recognized complication during hernia surgery that may lead to infertility, chronic pain, and spermatic granulomas[8, 12]. Identification of the vas deferens during exploration of the cord for a hernia sac therefore is considered mandatory in order to prevent its iatrogenic injury. In patients with a unilateral duplicated vas deferens, the anatomic variant may not be recognized, resulting in increased chances of intra-operative injury and subsequent complications. Although the duplicated vas may be smaller or incomplete, the complications associated with its injury are the same i.e. scarring of the vas deferens with obstruction, spermatic granulomas, and chronic pain. With a large number of inguinal hernia repairs performed annually, surgeon's awareness of this possible anatomic anomaly is necessary in order to minimize the risk of complications [8–14].
Duplication of vas deferens is rare with only few cases reported in the world literature. A hernia surgeon needs to be aware of this anomaly in order to avoid injury to this vital structure. Routine identification of vas deferens and awareness about this anomaly during surgery is therefore strongly recommended.
A written informed consent was taken from the patient regarding publication of this case report in any journal.
- Gray's Anatomy: Commemorative edition. Edited by: Pick, Howden. 1901, New York: Bounty Books, 1021.Google Scholar
- Erdemir F, Parlaktas BS, Adem Yasar, Uluocak N: Duplicated Vas Deferens: A rare congenital abnormality. Kaohsiung J Med Sci. 2008, 24 (4): 210-211. 10.1016/S1607-551X(08)70119-0.View ArticlePubMedGoogle Scholar
- Atug F, Turkeri L: Partial duplication of the vas deferens at the level of inguinal canal. Int J Urol. 12 (8): 773-775.Google Scholar
- Binderow SR, Shah KD, Dolgin SE: True duplication of the vas deferens. Journal Of Pediatric Surgery. 1993, 28 (2): 269-70. 10.1016/S0022-3468(05)80293-3.View ArticlePubMedGoogle Scholar
- Amelar RD, Dubin L, Walsh PC: Embryology, anatomy and physiology of the male reproductive tract. Male Infertility. 1977, Philadelphia: W. B. Saunders, 26.Google Scholar
- Vohra S, Morgentaler A: Congenital anomalies of the vas deferens, epididymis and seminal vesicles. Urology. 1997, 49: 313-10.1016/S0090-4295(96)00433-5.View ArticlePubMedGoogle Scholar
- Damle S, Cothren C, Moore E, Kim FJ: Double Trouble: Duplication of Vas Deferens Encountered During Inguinal Hernia Repair. J Am Coll Surg. 2005, 201 (1): 141-10.1016/j.jamcollsurg.2004.12.031.View ArticlePubMedGoogle Scholar
- Mathe CP, Dunn G: Double vas deferens associated with solitary kidney. J Urol. 1948, 59: ; 461.PubMedGoogle Scholar
- Silich RC, McSherry GK: Spermatic granuloma: An uncommon complication of the tension-free hernia repair. Surg Endosc. 1996, 10: 537-539. 10.1007/BF00188403.View ArticlePubMedGoogle Scholar
- Mysorekar VR: Accessory vas deferens a case report. Br J Urol. 1976, 48 (1): ; 82-10.1111/j.1464-410X.1976.tb02749.x.View ArticlePubMedGoogle Scholar
- Yeats WK: Urology. Edited by: Blandy JP. Oxford: Blackwell, 11: 1279.Google Scholar
- Carr R, Private medical clinic. Blyth: Apparent Bilateral Duplication of the Vas Deferens. British Journal of Urology. 1993, 71: 354-360. 10.1111/j.1464-410X.1993.tb15958.x.View ArticlePubMedGoogle Scholar
- Sheynkin YR, Hendin BN, Schlegel PN, Goldstein M: Micro-surgical repair of iatrogenic injury to the vas deferens. J Urol. 1998, 159: 139-141. 10.1016/S0022-5347(01)64036-9.View ArticlePubMedGoogle Scholar
- LeBlanc KA: Complications associated with the plug-and-patch method of inguinal herniorrhapy. Hernia. 2001, 5: 135-138. 10.1007/BF01576164.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.