Testicular ischemia after inguinal hernia repair

Abstract

KEYWORDSTesticular ischemia; Ultrasonography; Color-Doppler; Inguinal hernia repair.Abstract Testicular ischemia is a rare complication of inguinal hernia repair. It results from the injury to the vessels that course along the inguinal canal. Typically it is painful at the beginning and asymptomatic later. Ultrasonographic appearance and aspects of testicular ischemia result in diffusely hypoechoic and disomogeneous testis, with complete lack of intratesticular vascular signal on color-Doppler and cremasteric vessels hypertrophy in chronic cases. This report describes a testicular ischemia seen in a patient referred to because of hernia recurrence, without any sign or symptom of acute scrotum. Ultrasound examination showed the most frequent complications after inguinal hernia repair: both hernia recurrence and testicular ischemia.Sommario L'ischemia testicolare è una delle rare complicanze dell'intervento chirurgico di ernioplastica inguinale. É dovuta a compromissione della vascolarizzazione dei vasi che decorrono nel canale inguinale e si manifesta con dolore, per poi diventare asintomatica. Ecograficamente il testicolo appare ipoecogeno, con struttura modicamente disomogenea e assenza di vascolarizzazione alla valutazione color Doppler; nei casi cronici può essere presente ipertrofia dei vasi cremasterici. Viene presentato un caso di ischemia testicolare post-intervento chirurgico di ernioplastica, in paziente giunto alla nostra osservazione nel sospetto di recidiva d'ernia, senza sintomi di scroto acuto. L'esame ecografico ha mostrato la presenza di entrambe le complicanze post-intervento più frequenti: recidiva d'ernia ed ischemia testicolare. ª

Computed tomography options in the evaluation of hernia repair outcomes using “titanium silk” mesh implants

“…In postoperative period, ultrasound examination in many cases allows detection of complications and functional conditions, for example, to visualize fluid formations in the area of intervention (hematoma and seroma), adhesion of the internal organ to the implant surface, impaired blood supply to the scrotal organs after inguinal hernia repair, and so forth. Ultrasound examination is an operator‐dependent method (Dellabianca, Bonardi, & Alessi, 2011; Jamadar et al, 2011).…”

Testicular Infarction Post Inguinal Hernia Repair: Would a laparoscopic approach have helped reduce the risk?

“…Other rarer causes include inguinal hernia repairs and severe epididymitis [1,3,4]. As with Mr A, patients usually experience pain and swelling which may become asymptomatic later [2].…”

“…Collateral arterial supply exists from the cremasteric artery and artery to the vas deferens. Venous drainage is via the pampiniform plexus to the testicular veins [1].…”

“…Ischaemic orchitis leading to testicular atrophy occurs in 0.2-1.1% of all inguinal hernia repairs [1]. It typically presents 2-3 days after the surgery and can lead to infarction [2].…”

A rare complication after inguinal hernia repair: testicular torsion

“…Recurrence of hernia (0.3%-3.8%) is the most common complication, followed by injury to the vas deferens (1.6%) and injury to the vessels; in particular injury to the spermatic vessels can result in ischemic orchitis and lead to testicular atrophy (0.2%-1.1%). Unusual complications include testicle entrapment in the inguinal canal, wound infections, ilio-inguinal, ilio-hypogastric and genitofemoral nerve damage [9]. In both experimental and clinical studies reported that, after both open and laparoscopic hernia repair with mesh, causes scar and testicular ischemia are rarely observed.…”