Testicular infarction as a sequela of inguinal hernia repair

Testicular atrophy and necrosis as a result of ischemic orchitis is a well-established complication after inguinal hernia repair. We reviewed four patients with a recent history of inguinal hernia repair and subsequently developed ischemic orchitis to evaluate management options to provide symptomatic relief and prevent testicular atrophy.

The first patient underwent loosening of inguinal hernia mesh for scrotal pain and decreased arterial testicular flow 8 hours after inguinal hernia repair. The second patient developed ischemic orchitis 20 hours after inguinal herniorrphaphy and required removal of mesh. Neither patient had testicular atrophy at their follow up visit. The third patient underwent orchiectomy for testicular pain and intraoperative findings of infarction. The fourth patient never experienced pain but showed testicular atrophy 6 months after inguinal hernia repair and was managed expectantly.

In our series, testicular ischemia was reversed in two of the four patients with mesh loosening or removal. Prompt evaluation and exploration of suspected ischemic orchitis after inguinal hernia repair may allow symptomatic relief and prevention of testicular atrophy.