Testicular Necrosis Following Inguinal Herniorrhaphy: A Case Report

Testicular necrosis is a rare complication associated with inguinal herniorrhaphy.The main blood supply to the testicles comes from the testicular artery (internal spermatic artery), which branches off from the abdominal aorta; the external spermatic artery, which branches off from the inferior epigastric artery; and the arteries supplying the vas deferens.The testicles are extremely resistant to necrosis.Although early surgical intervention may reverse testicular ischemia, delayed diagnosis can necessitate orchiectomy.We report a case of testicular necrosis shortly after radical inguinal herniorrhaphy requiring orchiectomy following emergency exploration.A 73-year-old man presented to our hospital 18 months after undergoing robot-assisted radical prostatectomy.He developed a left inguinal hernia following radical prostatectomy and subsequently underwent inguinal herniorrhaphy.On the fifth postoperative day, the patient presented to the hospital complaining of pain and swelling in the left testicle.Physical examination revealed swelling of the left scrotum, and scrotal ultrasonography showed no blood flow in the left testicle.Emergency scrotal exploration for suspected testicular necrosis revealed scrotal skin thickening and black discoloration of the testis and epididymis without evidence of strangulation.Owing to absent testicular blood flow on intraoperative ultrasonography, left orchiectomy was performed.Histopathological examination revealed hemorrhage and ischemic necrosis.When scrotal pain, erythema, or swelling develops after inguinal surgery, prompt evaluation with scrotal ultrasonography is warranted, and the potential need for emergency surgical exploration should be considered.