Testicular failure in an adolescent with mesoappendicular testis.

A fifteen-year-old male presented with delayed puberty and cryptorchidism. Previous exploratory surgery for bilateral cryptorchidism resulted in left orchiectomy. The right testis was very high and intimately adherent to the mesentery of the appendix, and was left in situ. Subsequently progressive testicular failure was demonstrated by falling plasma testosterone and rising plasma gonadotropin levels. On elective surgical exploration, an atrophic testis with an independent blood supply was found adherent to the mesentery of the appendix. No spermatic duct was present, and orchiectomy was performed. The reasons for orchiectomy and the role of serial hormonal evaluations in the management of this unusual mesoappendicular testis case are reviewed.