Sato Keita, Hashiba Natsuki, Takahashi Koji, Shibuya Hirotaka
Department of Surgery, Ise Red Cross Hospital, Ise City, Mie, Japan.
Case Rep Surg. 2025 Mar 10;2025:9852275. doi: 10.1155/cris/9852275. eCollection 2025.
Cryptorchidism is one of the most common congenital anomalies in newborn males, with the majority diagnosed in infancy and treated surgically before puberty. In some cases, cryptorchid testes are discovered incidentally during inguinal hernia repair in adults, requiring appropriate management at the time of surgery. Case 1: A 58-year-old male underwent emergency laparoscopic surgery for a left incarcerated hernia. Intraoperatively, an M2 indirect inguinal hernia with omental strangulation of the spermatic cord was identified. Despite attempts to pull the testis down manually, it did not descend into the scrotum, leading to the diagnosis of cryptorchidism. The spermatic cord was excised and a 3D mesh was placed to cover the hernia defect. Case 2: A 33-year-old man with Noonan syndrome presented with localized pain and swelling in the right groin. Laparoscopy revealed an indirect L3 inguinal hernia and incidentally an intra-abdominal testis was found. The testis and spermatic vessels were found to terminate intra-abdominally, confirming the diagnosis of cryptorchidism. An orchiopexy was performed to secure the testis subcutaneously in the scrotum and the hernia was repaired with a 3D mesh. The safety of mesh-based hernia repair in cases of cryptorchidism with concomitant inguinal hernia has been previously reported. In cases where preoperative palpation is difficult due to pain, intraoperative traction of the testis may help differentiate between cryptorchidism and retractile testis. In addition, orchiopexy may serve as a temporary measure, with consideration of staged orchiectomy if necessary.
隐睾症是新生儿男性中最常见的先天性异常之一，大多数在婴儿期被诊断出来，并在青春期前接受手术治疗。在某些情况下，隐睾在成人腹股沟疝修补术中被偶然发现，需要在手术时进行适当处理。病例1：一名58岁男性因左侧嵌顿疝接受急诊腹腔镜手术。术中发现一个M2型间接腹股沟疝，精索被网膜绞窄。尽管试图手动将睾丸下拉，但它并未降至阴囊，从而诊断为隐睾症。切除精索并放置3D补片覆盖疝缺损。病例2：一名患有努南综合征的33岁男性，出现右侧腹股沟局部疼痛和肿胀。腹腔镜检查发现一个间接L3型腹股沟疝，偶然发现一个腹腔内睾丸。发现睾丸和精索血管在腹腔内终止，确诊为隐睾症。进行了睾丸固定术，将睾丸皮下固定在阴囊内，并用3D补片修复疝。先前已有报道在伴有腹股沟疝的隐睾症病例中基于补片的疝修补术的安全性。在因疼痛术前触诊困难的情况下，术中牵拉睾丸可能有助于区分隐睾症和回缩性睾丸。此外，睾丸固定术可作为一种临时措施，必要时考虑分期睾丸切除术。
