Abstract
BackgroundIschemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported.Case presentationThe patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy.ConclusionIschemic orchitis typically presents 2–3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach.
Highlights
Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported.Case presentation: The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left
Atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach
Ischemic orchitis was noted in a small number of these patients, but none resulted in testicular atrophy
Summary
Testicular ischemia and necrosis after laparoscopic surgery is an uncommon complication that is reported rarely in the literature. The most likely cause of the right testicular infarction in our case was the cautery excision of the right direct hernia sac that led to venous injury. This maneuver was compromised by less than optimal visualization secondary to the narrow male pelvis aggravated by the pneumoperitoneum. Despite the more likely diagnosis of right testicular infarction secondary to the recent laparoscopic inguinal hernioplasty, torsion of the testicle had to be considered. Leaving a necrotic right testicle in situ could have impacted subsequent fertility by inducing autoimmunization against spermatozoa[14] This patient was not informed of the rare possibility of orchiectomy as a complication of laparoscopic preperitoneal hernia repair.
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