A 20-cm redundant vas deferens loop during late orchidopexy: aberrant ductal anatomy as an intraoperative pitfall in a 17-year-old male

Abstract

Introduction and importance: Cryptorchidism is one of the most common congenital anomalies of the male genitourinary tract. Anatomical variations of the spermatic cord structures, though underreported, may increase the risk of iatrogenic injury during orchidopexy. Case presentation: A 17-year-old male presented with lifelong unilateral cryptorchidism. Preoperative ultrasonography localized the testis in a high inguinal position with preserved vascular flow. Given the patient’s informed refusal of orchiectomy despite counseling on malignancy risk, elective orchidopexy was performed. During surgery, an unusually long, redundant vas deferens loop measuring approximately 20 cm was identified. Through systematic proximal-to-distal tracing of the vas deferens and meticulous mobilization of the entire redundant segment, the structure was fully preserved. The testis was fixed in a tension-free subdartos pouch. Postoperative recovery was uneventful, with confirmed scrotal position at the 6-month follow-up. Conclusion: This case highlights a rare but surgically significant anatomical variant that may simulate a fibrous band or a duplicated structure and may be inadvertently divided during orchidopexy. Full identification of the cords’ contents before dissection of the cords is critical to avoid obstructive azoospermia. Surgeons should maintain heightened vigilance for ductal anomalies, particularly in older patients with prolonged cryptorchidism, in whom anatomical distortion is more likely.