Abstract
A 31-year-old man with no medical history presented to our emergency department with a painful swelling from the right inguinal region to the scrotum. On examination, an irreducible egg-sized lump was found in the right groin. Abdominal pelvic CT scan revealed protrusion of the small bowel and ascites in the right inguinal region. Emergent operation was performed with the preoperative diagnosis of incarcerated inguinal hernia. Surgical exploration revealed absence of the spermatic cord in the inguinal canal, and a strangulated small bowel and the right testis were present in the inguinal hernia sac. Small bowel resection was unnecessary because the bowel regained normal color. Orchidectomy was performed with the advice of a urologist, in addition to a ULTRAPRO® mesh repair.
Cryptorchidism is one of the most common birth defects in boys, and it is usually detected during newborn checkups. As an established risk factor for infertility and testicular cancer, early surgical treatment is recommended before puberty. In our case, we performed orchidectomy weighing the effect on fertility in unilateral cryptorchidism, and the risk of malignant change. Since inguinal hernia associated with cryptorchidism in an adult is rare, few cases have been reported worldwide, and only nine including our case in Japan. Nonetheless, we must always be alert to the possibility of cryptorchid testis during exploration of an inguinal hernia.
