Testicular seminoma presenting as an acute strangulated hernia: An intraoperative diagnosis

Testicular seminomas are the most common type of testicular tumor; atypical presentations can make diagnosis more challenging, leading to delayed treatment. Here, we present a 40-year-old previously healthy male who presented to the emergency department with severe right-sided scrotal swelling and pain. He had a diagnosed but untreated inguinal hernia. Physical examination revealed a large irreducible right inguinoscrotal swelling and tenderness. Doppler ultrasound reported herniated content in the right inguinal area, extending to the scrotum. Upon surgical exploration, a large right testicular tumor was discovered, surrounded by hematoma. A radical orchiectomy was performed, and the tumor was identified as a stage pT2 testicular seminoma. This case illustrates the diagnostic challenges posed by atypical presentations of testicular seminomas. A high index of suspicion and thorough clinical and radiological assessments are crucial for accurate diagnosis and management. In conclusion, large testicular seminomas presenting with acute pain mimicking strangulated hernias are rare. Comprehensive clinical and radiological evaluations are essential to avoid misdiagnosis and ensure appropriate surgical planning and patient management.