Testicle Ischemia Resulting from an Inguinal Hernia

Abstract

BackgroundScrotal pain in the emergency department (ED) should be evaluated rapidly for sources that may cause irreversible testicular ischemia. ObjectivesThis case report discusses a patient presenting with a large inguinal hernia causing testicle ischemia. Case ReportA 48-year-old man with a 1-year history of a large right-sided indirect inguinal hernia was transferred to the ED from the ultrasound laboratory after the patient experienced acute onset of severe right-sided testicular pain. The radiologist urgently called the attending emergency physician to notify him of ultrasound findings that showed compromised vascular flow to the right testicle. Urology and General Surgery were consulted immediately. The patient was placed in a supine position and reduction of the large hernia was attempted. After approximately 15min of manual pressure, the herniated bowel was reduced back into the abdominal cavity and the patient experienced immediate relief of his symptoms. ConclusionsScrotal ultrasound was repeated, and vascular flow to his right testicle was found to be re-established. This case highlights a rare presentation of acute onset of testicular ischemia caused by vascular compression from a large indirect inguinal hernia in an adult male.