Traumatic Testicular Dislocation Complicated by Torsion Post Hernioplasty: A Case Report

TL;DR

A rare case report describes testicular dislocation and torsion in a patient with a history of hernia surgery.

Contribution

This case highlights the rare and combined complications of traumatic testicular dislocation, torsion, and mesh-induced atrophy.

Findings

Testicular atrophy and torsion occurred in a patient with a prior hernioplasty.

Traumatic testicular dislocation was identified as a concurrent complication.

Mesh-induced fibrosis of testicular vasculature is suggested as a cause of atrophy.

Abstract

Testicular ischemia and atrophy are rare complications associated with inguinal hernia repair. Atrophy of the testicle can result in psychological distress along with infertility. This complication of inguinal hernia repair is associated with fibrosis of the testicular vasculature, resulting from the mesh used during routine hernia repair surgery. A 56-year-old male presented acutely with a tender left iliac fossa mass and pain. The patient gave a history of left inguinal hernia repair 10 years prior, which had proceeded without complication. Of note, the patient recounted an incident of testicular trauma in his early life, before any surgical intervention, after which he had experienced inability to palpate a left testicle. Upon acute presentation, the patient was clinically diagnosed with a recurrent left inguinal hernia with incarceration. He was promptly taken to the operating theatre. However, intraoperatively, instead of herniated intra-abdominal content, a torted, atrophic left testicle was noted at the superficial inguinal ring. Another rare testicular complication that presented simultaneously in this case was traumatic testicular dislocation (TTD). This condition is associated most often with blunt scrotal trauma and results in malposition of the testes out of the scrotum. We discuss a rare case of concomitant presentation of TTD, complicated by testicular atrophy and torsion in a single patient. A review of the relevant literature revealed that testicular atrophy, a rare complication of testicular ischemia, can result from the use of mesh in hernioplasty.

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