2006, Number 4
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Rev Mex Cir Pediatr 2006; 13 (4)
Infrequent finding in inguinal hernia Male pseudohermaphroditism. Case report
Mora-Rico K, Romero-Montes VE, Camacho-Coronado R
Language: Spanish
References: 14
Page: 181-186
PDF size: 60.71 Kb.
ABSTRACT
Introduction: intersex syndromes constitute or sexual ambiguity in pediatric surgery a complex problem and often is an emergency that must be resolved in the neonatal period, however, some groups are diagnosed in adolescence or during adulthood.
Intersex disorders are divided into four groups and it is rare that the intersex pseudohemafroditismo is presented as a male, where female external genitalia were observed in male gonads and Mullerian duct derivatives are absent or rudimentary.
Case report: We report a case of a teenage girl 12 years of age diagnosed with Syndrome Androgen Insensitivity as a finding during an inguinal hernia.
He was admitted with a diagnosis of right inguinal hernia, laparoscopic approach to finding a closed deep inguinal ring without the presence of hernia sac, it was decided to perform inguinal approach, finding as a finding testicular characteristics and age-appropriate size in the inguinal canal.
Subsequently new laparoscopic exploration is done by finding absence of uterus and ovary structure appears to be left, at which it takes testicular tissue biopsy reports.
Discussion: Disorders of sexual differentiation or intersex require a multidisciplinary assessment for sex assignment, since it depends on the patient’s future life, both in its function, social role, and the possibility of reproduction.
The intersex is not a problem of sexual identity in the patient, as they have assumed a sex (male or female) that he is not in doubt and not a psychological problem, because the patient has no perception of belonging to a third sex.
Pediatric surgeon in this situation should begin without a multidisciplinary study aimed at determining the true sex of the patient and direct role will be to perform gonadectomy and vaginoplasty.
REFERENCES
Aaronson I. Sexual differentiation and intersexuality. En: Clinical Pediatric Urology. 3era. Edición. Estados Unidos de America. W.B. Saunders Company, 1992; Vol. 2: p. 997-1012
Mónica Rascón Risco, Trastornos del desarrollo sexual, Rev Mex Ped 2001; 7: 101-107
Alfredo José Caraballo, Bestalia Sánchez, Antonio José Perera, Fanny Margot Carrero, Manuel Enrique Arias, Leonardo de Abreu. Tres hermanas con insensibilidad periférica a los andrógenos. Rev Obstet ginecol Venez 2001; 6: 61-65
Arikan, Yucel, Barut, Isik, Kocakusak. Irreducible inguinal hernia, bowlel Obstruction and torsion of testis in a patien with testicular feminización syndrome. J Pediatr Surg 2003; 2: 243-251
Burge, Sugorman. Exclusión of androgen insensitivity syndrome in girls with inguinal hernias: current surgical practice. Pediatr Sur Int 2002; 28: 701-703.
Julia Spencer, Barthold, Kandis Kumasi Rivers, Jyoti Upandhyay, Bijan Shekarriz, Julianne Imperato Jyoti. Testicular position in the androgen insentivity syndrome: Implications for the role of androgens in testicular descent. The J Urol 2002; 164: 497-501.
José Antonio Ramírez Velasco, Edgar Morales Juvera, Hermilo de la Cruz Yánez, Mario Díaz Pardo, Javier Quiroz Guerrero, Héctor Montalvo López. El niño con genitales ambiguos. Tratamiento quirúrgico. Rev Med IMSS 2002; 40: 15-17.
de Haro Guerrero F, González González C, Giraldo Ansio F. Malformaciones congénitas del aparto genital externo femenino. Reconstrucción de la vulva. En: Manual de Cirugía Plástica 2da. Edición. Málaga España, Organización Diana, 1992; Vol. 2: p. 147-155.
Cristián Pomes, Nicanor Barrena. Intervenciones quirúrgicas; Síndrome de Mayer-Rokitansy- Küster-Hauser: Experiencia con vaginoplastia por tracción laparoscopica. Rev Chil Obstet Ginecol 2003; 68: 42-48
Milton D, Paediatric management of ambiguos and traumatizad genital. J. Urol 2001;162: 1021-1028
Biro Biosca, Parrera LA ,Fernández M, Martín JA, Toran Fuentes, Diagnóstico y tratamiento quirúrgico de pseudohermafroditismo masculino en una unidad multidisciplinaria de estados intersexuales.J Cir Pedia 2004; 17:70-75
Pedro Alemán, Juan Antonio Suárez, Mario Gutierrez, Daylanis Victoria Figueroa, Osmany Alba, Armando Iglesias. Rev Cub Ana Pat; 2005; 1y2: 27-42.
Cristian Pomes, Nicanor Barrera. Síndrome de Mayer-Rokitansky experiencia con vaginoplastia por tracción laparoscópica. Rev Chil Obst Gin 2003;68:42-48.
Rutgers J L. The androgen insensitivity syndrome (testicular feminization): a model for testicular desdcent in mice and men. J. Pediatr Surg 2005;21:164-172.