Case History/examination
The index case was 45 days old male infant born to para-III mother delivered at home with no antenatal care follow up, historically presented with right side abdominal distension since birth. Otherwise the infant was fine and no other complaint. This patient vital sign and anthropometry was normal for age. On clinical examination the abdomen is distended and soft on the right side but normal on left side (Fig.1). For this patient presentation abdominal ultrasound was done at our hospital.
On ultrasound left side abdominal wall muscles (both rectus abdominis and oblique muscles) were visualized with normal thickness and echotexture (Fig.2). Right side of midline no abdominal wall muscles visualized (Fig.2). Bowel loops wall was visualized just beneath the abdominal wall subcutaneous tissue. On further assessment only left testis was visualized in scrotal sac with minimal surrounding fluid. Right scrotal sac was not developed and the right testis was not visualized in inguinoscrotal region (Fig.3A). There was 9mm by 7mm measuring oval shaped structure seen in right side of retroperitoneum anterior to right psoas muscle just below the renal hilum (Fig.3B). The oval shaped structure has similar shape and echotexture to left side intrascrotal testis. Bilateral kidneys are located in normal position with no evidence of hydronephrosis (Fig 4A).The urinary bladder was minimally distended with urine (estimated volume of 20cc) with normal wall thickness (Fig.4B).