A giant inguinoscrotal
hernia is a rare
inguinal hernia that extends below the midpoint of the inner thigh while standing. Although reports of laparoscopic surgery for giant inguinoscrotal
hernias have increased, the risk of delayed
hematocele has not yet been clarified.
CASE PRESENTATION: A 68-year-old man was evaluated for a left giant inguinoscrotal
hernia, and laparoscopic transabdominal preperitoneal repair (
TAPP) was performed. In the procedure, the distal
hernia sac was not resected. The postoperative course was uneventful for 3 months postsurgery, after which he complained of giant scrotal swelling, which gradually grew to 13 cm. It did not improve with several
punctures and caused
dysuria because of increased pressure on the urethra. Thus, reoperation was performed 9 months after surgery. The
hematocele consisted of a thickened
hernia sac, which was tightly adhered to the spermatic cord and testicle. The
hernia sac including the
hematocele was removed from the scrotum through an anterior approach, preserving the spermatic cord and testicle. On the third postoperative day, an
orchiectomy was performed due to poor testicular perfusion caused by spermatic cord injury. There was no
hematocele or
hernia at the 3-year follow-up. The remnant sac after laparoscopic
TAPP for a giant inguinoscrotal
hernia possibly caused refractory
hematocele. Additionally, the removal of the
hernia sac, including
hematocele, from the spermatic cord and testicle has a risk of inducing injury, leading to
orchiectomy.
CONCLUSION: