Spermatic granuloma. An uncommon complication of the tension-free hernia repair.

A patient with a sperm granuloma following a tension-free hernia repair utilizing Marlex mesh 4 years prior to presentation is described. The mechanism of granuloma formation is believed to be secondary to vas deferens injury due to erosion by the cut edges of the mesh at the medial end of the slit used to recreate the internal inguinal ring. Spermatic granuloma has been rarely described in hernia surgery and requires a previous vas deferens injury. While the more common and clinically significant events of hernia recurrence and wound infection should be considered first, the occurrence of spermatic granuloma as a cause of postoperative pain or a mass should be included in the differential diagnosis.