Kefalas Charalampos, Karlafti Eleni, Zatagias Apostolos, Karakatsanis Anestis, Tsakiris Georgios, Michalopoulos Antonios, Paramythiotis Daniel
1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece.
Emergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
Ann Med Surg (Lond). 2022 Aug 1;80:104288. doi: 10.1016/j.amsu.2022.104288. eCollection 2022 Aug.
And importance: The most common postoperative complications after inguinal hernia repair are hernia recurrence, hematoma, seroma, wound infection, chronic pain, numbness and swelling. The aim of this case report is to present a rare complication of inguinal hernia repair, a large scrotal abscess that was caused by an inoculated scrotal hematoma 3 months after Transabdominal Preperitoneal bilateral inguinal hernia repair.
An 84-year-old patient presented to the emergency department complaining about fever, pain and progressive swelling of the left hemiscrotum. He had undergone a Transabdominal Preperitoneal bilateral inguinal hernia repair 3 months earlier and a scrotal paracentesis 17 days earlier due to a scrotal hematoma. The pelvic CT scan was indicative of a large abscess in the left hemiscrotum compressing the ipsilateral testicle. Surgical exploration of the inguinal area was performed and considering the patient's advanced age the abscess was excised "en bloc" with the ischemic ipsilateral testicle. The patient had an uneventful recovery and was discharged home on the third postoperative day.
Scrotal abscess, although rare, should be considered in the differential diagnosis of scrotal pain after inguinal hernioplasty. Scrotal drainage is sometimes used in order to relive the patient's discomfort caused by a swollen scrotum, but if not performed properly it can lead to serious infections. Postoperatively, a suction drain or elevation and compression of the scrotum may prevent scrotal complications.
Scrotal abscess is a rare complication of inguinal hernioplasty. Scrotal care pathways establishment after inguinal hernia repair could help reduce and manage complications.
及其重要性：腹股沟疝修补术后最常见的并发症是疝复发、血肿、血清肿、伤口感染、慢性疼痛、麻木和肿胀。本病例报告的目的是呈现腹股沟疝修补术一种罕见的并发症，即经腹腹膜前双侧腹股沟疝修补术后3个月，接种性阴囊血肿导致的巨大阴囊脓肿。
一名84岁患者因左侧阴囊发热、疼痛和进行性肿胀就诊于急诊科。他3个月前接受了经腹腹膜前双侧腹股沟疝修补术，17天前因阴囊血肿接受了阴囊穿刺引流。盆腔CT扫描显示左侧阴囊有一个巨大脓肿，压迫同侧睾丸。对腹股沟区进行了手术探查，考虑到患者年事已高，将脓肿与缺血的同侧睾丸“整块”切除。患者术后恢复顺利，术后第三天出院。
阴囊脓肿虽然罕见，但在腹股沟疝修补术后阴囊疼痛的鉴别诊断中应予以考虑。有时会进行阴囊引流以缓解阴囊肿胀给患者带来的不适，但如果操作不当可能会导致严重感染。术后，使用吸引引流管或抬高并压迫阴囊可能预防阴囊并发症。
阴囊脓肿是腹股沟疝修补术的一种罕见并发症。建立腹股沟疝修补术后的阴囊护理路径有助于减少和管理并发症。
