Torsion of an Indirect Hernia Sac Causing Acute Scrotal Swelling in a Child
A 6-year-old boy presented to the emergency room with acute pain and scrotal swelling in the right hemiscrotum for the past two days. Physical examination elicited mild fever, and the patient was in severe distress. The left testicle felt normal on palpation. The right hemiscrotum was tense and edematous. The right testicle could not be easily palpated. The cremasteric reflex was present bilaterally. Urine analysis, complete blood count, and routine blood chemistry results were unremarkable. A Doppler ultrasound of the testis demonstrated a multiseptated peritesticular cystic mass with hydrocele in the right side measuring 2.8 cm×2.4 cm×3.0 cm in size (). A scrotal exploration was performed and during surgery, a tense, dark purple, and cystic sac was evident superior to the right testis (). The necrotic cyst consisted of torsion of a hernia sac that communicated directly with the peritoneum, was twisted in an angle of about 360°, and contained no bowel or omentum (). Through a second incision in the inguinal region, the hernia sac was dissected free from the cord, ligated, and excised at the level of the internal ring. The scrotal and inguinal incisions were closed. The pathologic diagnosis was a hernia sac of the peritoneum accompanied by bleeding, congestion, necrosis, and fibrosis. The patient was discharged the following day, and the postoperative course was uneventful.