國泰綜合醫院 外科部 泌尿科
Left Incarcerated Inguinal Hernia Inducing Testicular Ischemia: Case Report and Literature Review
Chung-Tso Chen, Chin Tang, Teh-Sheng Hsieh
Divisions of Urology, Department of Surgery, Cathy General Hospital, Taipei, Taiwan;
Acute scrotal pain is a common complaint in a urological practice and should be evaluated rapidly for sources that may cause irreversible testicular ischemia. Testicular compromise, most commonly due to testicular torsion, was rarely related to inguinal hernia. However, vascular compromise due to physical compression from a herniatic bowel or omentum still needs to be considered and requires immediate exclusion, as presented in our case.
We present a case of 19-years-old male with acute left testis swelling and pain. On physical examination, enlarge and high-riding left testis were noted. Testicular ultrasound revealed detectable bilateral testis blood flow. Testicular torsion was suspected due to history and finding of the physical examination. Emergent scrotal exploration was then performed. However, hernia sac with omental fat strangulating the spermatic cord was discovered once we opened the tunica vaginalis, and the left testis was pale with nearly normal orientation. Left testis compromised due to left incarcerated inguinal hernia was impressed. An inguinal incision was made and herniorrhaphy was performed, releasing the hernia sac and reducing it smoothly. Dramatically, the left testis regained normal color and appearance after the hernia sac reduction. The patient was discharged shortly after the operation. We will present this case and review the relative literature.