Inguinal Incarcerated Hernia with Unilateral Cryptorchidism - A case report
Hsuan-Ting Kuo, Chin-Wei Yang, Chia-Lun Huang, Chieh-Chen, Hsieh, Hsiao-Hsian Wang, Kuang-Kuo Chen, Luke S. Chang and Sheng-Han Tsai
Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan
Introduction: Cryptorchidism is one of the most common congenital abnormalities in male neonates but rarely discovered in adult patients, with one percent incidence rate from one year old to adulthood. An abdominal undescended testis is usually associated with a patent processus vaginalis, which increases the risk of inguinal hernia even incarceration. We hereby present an adult case of inguinal incarcerated hernia with unilateral cryptorchidism.
Presentation of case: A 46-year-old man who denied any medical comorbidities presented with right inguinal protruding mass for more than 40 years, experiencing pain and discomfort in recent months. Physical examination revealed a non-reducible mass with tenderness over right scrotum. Computed tomography of lower abdomen disclosed right inguinal hernia entrapping the omentum inside the huge sac. The small testicle can be identified in the peritoneal cavity lateral to the herniated omentum. Right inguinal hernioplasty with Bassini's method, omentum excision and right orchiectomy were done. A large indirect hernia sac containing omentum and the atrophic right testicle were noted intraoperatively without visible spermatic cord. Pathology report confirmed an atrophic testis without evidence of malignancy. There is no spermatogenesis of the seminiferous tubules (Sertoli-cell only).
Discussion: Inguinal incarcerated hernia with a cryptorchid testis is rare in adulthood patient group, with only few cases found in the literature. Patients described in previous case reports who presented with inguinal hernia and cryptorchidism would not be difficult to diagnose because of impalpable testis in the ipsilateral hemiscrotum in the physical examination. In our case, however, detection of cryptorchidism become challenging when incarcerated hernia to scrotum occurred. Further image study might be indicated to confirm pre-operative diagnosis.