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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 70  |  Issue : 3  |  Page : 173-175

A rare case of anomalous origin of bilateral testicular arteries: An anatomical and developmental overview


Department of Anatomy, AIIMS, New Delhi, India

Date of Submission09-Oct-2019
Date of Acceptance03-Dec-2020
Date of Web Publication23-Sep-2021

Correspondence Address:
Dr. Saroj Kaler Jhajhria
Department of Anatomy, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JASI.JASI_140_19

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  Abstract 


An extensive knowledge of the origin and course of testicular arteries (TAs) is indispensable during various surgical procedures such as renal transplant, intra-abdominal surgeries, and even in orthopedic surgeries such as spine surgery. With the advent of new intra-abdominal therapeutic and diagnostic techniques, the anatomy of TAs has assumed much more significance. Although the variations of the testicular vein are well documented, the variations of the TA are not so frequent in incidence. We report a rare case of bilateral aberrant origin of the TA from polar renal arteries. Though anomalies of the polar arteries supplying the kidney are common, bilateral origin of TAs from them is a rare presentation. We also discuss its developmental basis. Such anomalies if left unnoticed will lead to serious intraoperative complications during procedures on retroperitoneal organs. Any damage to the TAs will compromise the function of the gonads.

Keywords: Abdominal aorta, inferior renal polar artery, renal artery, suprarenal arteries


How to cite this article:
Ganapathy A, Banerjee A, Jhajhria SK, Singh S. A rare case of anomalous origin of bilateral testicular arteries: An anatomical and developmental overview. J Anat Soc India 2021;70:173-5

How to cite this URL:
Ganapathy A, Banerjee A, Jhajhria SK, Singh S. A rare case of anomalous origin of bilateral testicular arteries: An anatomical and developmental overview. J Anat Soc India [serial online] 2021 [cited 2021 Dec 3];70:173-5. Available from: https://www.jasi.org.in/text.asp?2021/70/3/173/326422




  Introduction Top


Abdominal aorta being the sole purveyor of all organs in the abdomen is quite legendary for anomalies not only of its own but also due to its fellow branches. This provokes different types of pathogenesis of different organs; hence, an utmost knowledge of varying patterns of abdominal aorta and its branches evokes great importance in medical stream. Varying patterns of testicular artery (TA) is one of them.

Each TA originates from the abdominal aorta, at the level of second lumbar vertebra, 2.5–5 cm inferior to the origin of the renal artery. It traverses inferolaterally under the parietal peritoneum, along psoas major, toward the pelvis. It then enters the deep (internal) inguinal ring and travels along the ipsilateral spermatic cord in the inguinal canal to the scrotum and supplies ipsilateral testis.[1] Though the variations of testicular vein are well documented, the variations of TA are not so frequent in incidence. Most of these anomalies are related to the origin of TA. The knowledge of varying patterns of TA is not only significant in testicular and renal pathology but is also of utmost importance in various surgical procedures.


  Case Report Top


During the routine dissection of an embalmed elderly male cadaver in the Department of Anatomy, AIIMS, New Delhi, we encountered an anomalous origin of bilateral TAs from the polar arteries which were supplying the lower pole of the corresponding kidneys. The renal arteries were seen separately originating from the abdominal aorta. On each side, the TA traversed inferolaterally under the parietal peritoneum with the testicular vein, along psoas major. It then crossed the ureter, toward the pelvis. Finally, it entered the deep inguinal ring to supply the testis [Figure 1]. The length of the right TA was 17.6 cm and that of the left was 17.6 cm from its origin up to the deep inguinal ring. There were no visible structural anomalies in the kidneys and testicles.
Figure 1: The different retroperitoneal structures in the posterior abdominal wall

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  Discussion Top


Asala et al. reported anatomical variations of the TA in 4.7% of 150 cadavers. The variations reported by them were related to the origin of TA, which were either from unusually high levels of the abdominal aorta or from the renal artery. In four cases, they reported that the right TA was a branch of the right renal artery and in one of these, the right TA gave rise to the right inferior suprarenal artery.[2]

Different types of anomalies related to TA, such as the absence of one of the arteries; common origin of both arteries; double arteries; and high origin from the aorta and origin from the lumbar, renal, middle, and superior suprarenal arteries, were documented by Bergman et al.[3]

Pai et al. documented different types of anomalies of TA and classified them. In 85.3% of cases, the origin of TA was normal and in the remaining 14.7%, various anomalies were observed, as follows: variation 1 – in 7.4% of cases, TA was a branch of the inferior renal polar artery; variation 2 – the TA was a branch of the main renal artery on the right side; variation 3 – TA with high origin, at the level of the origin of the renal artery mainly in the left side; and variation 4 – duplication of TA on the right side. There were double TAs – the lateral and the medial TAs.[4] The present case is similar to variation 1 as described by Pai et al. They have mentioned this kind of variation in three right- and two left-sided TAs but did not mention the bilateral anomalous origin of TAs in the same cadaver, as seen in the present case.

Machnicki and Grzybiak reported the varying patterns of TA in fetuses as well as adults and grouped them. They documented four major types as follows: Type A – a single TA originating from the aorta; Type B – a single TA originating from the renal artery; Type C – two TAs originating from the aorta that supply the same gonad; Type D – two TAs supplying the same gonad, one arising from the aorta and the other from the renal artery. The present case has not been categorized under any of them. Here, TA originated from the lower polar artery bilaterally.[5]

Ciçekcibaşi et al. classified the TA according to its origin into four distinct types, as follows: Type I – TA arising from the suprarenal artery; Type II – TA originating from the renal artery; Type III – TA of high origin from the abdominal aorta, close to the origin of renal artery; and Type IV – duplication of TA at its origin from the aorta or from various vessels. The present case did not fall under any of the above-said classifications.[6]

Bordei et al. reported four cases of a single genital artery arising from supplementary renal arteries.[7] In their study done on forty cadavers, Mamatha et al. have mentioned that 20% of the cadavers showed variation in the origin of TAs. A single cadaver showed bilateral variations in the origin of TA from accessory renal arteries.[8] Singh et al. found bilateral origin of the ovarian arteries from the accessory renal arteries,[9] whereas we found the same variation in the case of TA. Kayalvizhi et al. in their review on anatomical variations on TA have mentioned that very few reports were found on variations in TA with respect to their origin from other sites, thus signifying the importance of reporting the present case.[10]

Our findings matched with that of Shoja et al. They documented the incidence of gonadal artery originating from the main or accessory renal artery in 14% of cases, among which in 7% of cases, it originated from the inferior renal polar artery.[11]

On embryological basis, Keibel et al. divided nine pairs of lateral mesonephric arteries arising from the dorsal aorta into the following three groups: cranial group – the 1st and 2nd arteries; middle group – the 3rd to 5th arteries; and caudal group – the 6th to 9th arteries. Any of the mentioned nine arteries may become the gonadal artery. It usually arises from the caudal group.[12]

The origin and course of TA has to be identified carefully during various surgical procedures such as renal transplant, intra-abdominal surgeries, and even in orthopedic surgeries such as spine surgery. Radiologists should have an immense knowledge on the different types of TAs for making an accurate diagnosis. Knowledge of these variations may also provide safety guidelines for endovascular procedures such as therapeutic embolization and angioplasties.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Standring S. Gray's Anatomy, The Anatomical Basis of Clinical Practice. 41th ed. London: Elsevier Churchill Livingstone; 2005. p. 1272.  Back to cited text no. 1
    
2.
Asala S, Chaudhary SC, Masumbuko-Kahamba N, Bidmos M. Anatomical variations in the human testicular blood vessels. Ann Anat 2001;183:545-9.  Back to cited text no. 2
    
3.
Bergman RA, Thompson SA, Afifi A K. Catalog of Human Variation. Baltimore: Urban and Schwarzenberg; 1984. p. 119.  Back to cited text no. 3
    
4.
Pai MM, Vadgaonkar R, Rai R, Nayak SR, Jiji PJ, Ranade A, et al. A cadaveric study of the testicular artery in the south Indian population. Singapore Med J 2008;49:551-5.  Back to cited text no. 4
    
5.
Machnicki A, Grzybiak M. Variations in testicular arteries in foetuses and adults. Folia Morphol (Warsz) 1997;56:277-85.  Back to cited text no. 5
    
6.
Ciçekcibaşi AE, Salbacak A, Seker M, Ziylan T, Büyükmumcu M, Uysal II, et al. The origin of gonadal arteries in human fetuses: Anatomical variations. Ann Anat 2002;184:275-9.  Back to cited text no. 6
    
7.
Bordei P, Sapte E, Iliescu D. Double renal arteries originating from the aorta. Surg Radiol Anat 2004;26:474-9.  Back to cited text no. 7
    
8.
Mamatha H, D'Souza AS, Vinodhini P, Ray B, Suhani, Pallavi. A Cadaveric Study about the Anomalous origin of testicular arteries arising from the accessory renal arteries. Indian J Surg 2015;77:111-6.  Back to cited text no. 8
    
9.
Singh G, Ng YK, Bay BH. Bilateral accessory renal arteries associated with some anomalies of the ovarian arteries: A case study. Clin Anat 1998;11:417-20.  Back to cited text no. 9
    
10.
Kayalvizhi I, Narayan RK, Kumar P. Anatomical variations of testicular artery: A review. Folia Morphol (Warsz) 2017;76:541-50.  Back to cited text no. 10
    
11.
Borderud SP, Li Y, Burkhalter JE, Sheffer CE, Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer 2014;120:3527-35.  Back to cited text no. 11
    
12.
Keibel F, Mall F. Manual of Human Embryology II. Philadelphia: J. B. Lippincott; 1912. p. 820-5.  Back to cited text no. 12
    


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