Undescended testis with Spigelian hernia: A rare association treated laparoscopically

Abstract

Spigelian hernia (SH) is rarely seen in the pediatric population and it is usually associated with undescended testis on the ipsilateral side. The condition has remained a question as to whether this is a cause, effect, or a new syndrome. Herein, we report the case of a 2-year-old child with right iliac region swelling that bulges out when he cries and the swelling disappears when he is sleeping. There was no vomiting or constipation. The parents also noticed the absence of the right testicle since birth. Examination revealed a reducible swelling in the right iliac region. The right hemiscrotum was hypoplastic and the testicle was not palpable. A diagnosis of right-sided Spigelian hernia with ipsilateral cryptorchidism was made. Contrast-enhanced computed tomography scan (CECT) did not reveal a hernia defect and the testicle was not localized. The hernia was repaired laparoscopically. The testes were found in the hernia sac and orchidopexy effected. The cryptorchid testis was a content of hernia sac which is a rare occurrence. Swelling in the iliac region in combination with ipsilateral undescended testes should be carefully evaluated. When the diagnosis of SH is established, it can be successfully repaired laparoscopically.