# An Incarcerated Inguinal Hernia Initially Misdiagnosed as a Spermatic Cord Hydrocele: An Educational Case Report

## TL;DR

A man initially thought to have a spermatic cord hydrocele was later found to have an incarcerated inguinal hernia, highlighting the need for careful reassessment of groin swellings.

## Contribution

This case report emphasizes the diagnostic challenge of coexisting spermatic cord hydrocele and inguinal hernia, and the importance of using multiple imaging techniques for accurate diagnosis.

## Key findings

- Contrast-enhanced CT revealed an incarcerated inguinal hernia despite initial MRI diagnosis of spermatic cord hydrocele.
- Laparoscopic repair confirmed a hernia and a multilocular hydrocele adjacent to the hernia orifice.
- Manual reduction of the hernia was successful, and imaging confirmed resolution.

## Abstract

Spermatic cord hydrocele and inguinal hernia are both common causes of groin swelling in adult males, but their coexistence is rare and may lead to diagnostic challenges.

A 59-year-old man previously diagnosed with right spermatic cord hydrocele on magnetic resonance imaging (MRI) presented with new-onset right groin pain and swelling. The initial evaluation suggested worsening of the spermatic cord hydrocele symptoms. However, contrast-enhanced computed tomography (CECT) revealed an incarcerated right inguinal hernia containing bowel and adipose tissue. Manual reduction was successful, and subsequent imaging confirmed resolution. MRI also showed a 10-mm mass consistent with a spermatic cord structure. Elective laparoscopic hernia repair (transabdominal preperitoneal approach (TAPP)) identified a right external inguinal hernia, and a multilocular hydrocele was also found adjacent to the hernia orifice, and the hydrocele was treated with suction and cauterization.

This case highlights the importance of reassessing initial diagnoses when new symptoms arise. A variety of imaging approaches are necessary to differentiate between overlapping groin lesions accurately. Clinicians should consider the possibility of a secondary pathology, such as a hernia, when managing a previously diagnosed spermatic cord hydrocele with symptom progression.