A rare complication after inguinal hernia repair: testicular torsion

Year 2019, , 209 - 212, 04.01.2019

Yusuf Önder Özsağır Görkem Akça Mustafa Ozan Horsanalı , Hüseyin Eren , Eyüp Dil

https://doi.org/10.18621/eurj.381909

Abstract

Testicular torsion is the most common urological
emergency characterized by reduced blood flow of the testis, often due to
spermatic cord torsion occurring in adolescence. A 68-year-old male patient
admitted our hospital emergency service with the complaint of acute scrotal
pain for a week. On history, he had undergone right inguinal hernia repair with
synthetic mesh one week ago. Due to reduced blood flow of right testicular
artery on colored doppler ultrasonography, emergent surgery was performed. On intraoperative
examination, 360 degree torsion of spermatic cord from distal to the mesh,
thrombosis of right testicular artery and necrosis of testicular tissue was
observed. After detorsion of right testis, absence of blood supply to the right
testis was observed. According to these findings, right inguinal orchiectomy
was performed. It should be kept in mind that persistent pain may be a sign of
testicular torsion which may develop early after inguinal hernia repair with
synthetic polypropylene mesh. In suspicious of testicular torsion because of
persistent scrotal pain after inguinal surgery, scrotal colored doppler
ultrasonography must be performed immediately and consulted to the urologist. Succeed
results may be provided by multidisciplinary approach and early treatment. 

Keywords

Orchiectomy, testicular torsion, inguinal hernia repair, synthetic polypropylene mesh

References

• [1] Huang WY, Chen YF, Chang HC, Yang TK, Hsieh JT, Huang KH. The incidence rate and characteristics in patients with testicular torsion: a nationwide, population-based study. Acta Paediatr 2013;102:e363-7.
• [2] Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 2003;362:1561-71.
• [3] Pepe P, Aragona F. Testicular ischemia following mesh hernia repair and acute prostatitis. Indian J Urol 2007;23:323-5.
• [4] Peiper C, Junge K, Klinge U, Strehlau E, Krones C, Ottinger A, et al. The influence of inguinal mesh repair on the spermatic cord: a pilot study in the rabbit. J Invest Surg 2005;18:273-8.
• [5] Shin D, Lipshultz LI, Goldstein M, Barme GA, Fuchs EF, Nagler HM, et al. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 2005;241:553-8.
• [6] Akin EA, Khati NJ, Hill MC. Ultrasound of the scrotum. Ultrasound Q 2004;20:181-200.
• [7] Arena F, Nicotina P, Scalfari G, Visalli C, Arena S, Zuccarello B, et al. A case of bilateral prenatal testicular torsion: ultrasonographic features, histopathological findings and management. J Pediatr Urol 2005;1:369-72.
• [8] Pepe P, Panella P, Pennisi M, Aragona F. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? Eur J Radiol 2006;60:120-4.
• [9] Dellabianca C, Bonardi M, Alessi S. Testicular ischemia after inguinal hernia repair. J Ultrasound 2011;14:205-7.
• [10] Fong Y, Wantz G. Prevention of ischemic orchitis during inguinal hernioplasty. Surg Gynecol Obstet 1992;174:399-402.
• [11] Heifetz CJ. Resection of the spermatic cord in selected inguinal hernias: Twenty Years of Experience. Arch Surg 1971;102:36-9.
• [12] Holloway BJ, Belcher HE, Letourneau JG, Kunberger LE. Scrotal sonography: a valuable tool in the evaluation of complications following inguinal hernia repair. J Clin Ultrasound 1998;26:341-4.