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We report the case of a 21-month-old boy who was referred for the surgical management of a left undescended testis. A preoperative ultrasound examination was negative for supranumerary testis. Surgery revealed complete separation of the epididymis from the testis; one welldeveloped testis was found in the internal ring of the inguinal canal. A second atrophic testis was also detected in the inguinal canal and this was removed. Histological evaluation revealed the presence of an atrophic, undeveloped testis with its own epididymis and spermatic duct. The risk of malignancy in polyorchidism warrants the removal of an atrophic and ectopic testis. [ABSTRACT FROM AUTHOR]

Background/purpose: Modified Heller esophagomyotomy has become the initial treatment of choice for esophageal achalasia in children. However, only limited and not objective data are currently available on the long-term results of modified Heller limited esophagomyotomy (LEM). This retrospective study was undertaken to objectively assess the long-term results of LEM in childhood esophageal achalasia., Methods: Medical records of 15 patients with a median age of 9.5 years (range, 6-13 years) who underwent an LEM without an antireflux procedure from January 1991 to December 2005 were reviewed. Clinical scores, barium esophagogram, flexible upper alimentary endoscopy, 24-hour esophageal pH monitoring, and esophageal manometry before and 0.5 to 15 years after surgery were analyzed., Results: An excellent to good outcome was observed in 14 (93.3%) patients. One patient (6.7%) required reoperation 8 months after surgery because of persistent dysphagia. The late barium esophagogram showed a significant decrease (from 4.2 +/- 0.95 to 2.4 +/- 1.1 cm, P < .01) of esophageal diameter, as compared with preoperative values. Only 1 patient had grade II esophagitis on flexible upper alimentary endoscopy. Twenty-four- hour esophageal pH monitoring showed an abnormal acid exposure in 1 patient. The late esophageal manometry showed a significant decrease (from 31.7 +/- 7.9 to 7.8 +/- 3.7 mm Hg; < .05) of lower esophageal sphincter (LES) pressure, and only insignificant increase (from 18.8 +/- 6.2 to 21.4 +/- 8.4 mm Hg; NS) of amplitude of esophageal contractions over preoperative values., Conclusions: Transabdominal LEM without an antireflux procedure is an effective and safe treatment of esophageal achalasia in children because of its long-term high rate of symptoms relief and low incidence of postoperative complications, despite the lack of esophageal motility restoration to normal.