Aberrant Scrotal Extension of an Incarcerated Incisional Hernia With Testicular Displacement

Incisional hernias are common postoperative complications, whereas scrotal extension is usually associated with inguinal hernias traversing the inguinal canal. Scrotal involvement from a ventral incisional defect through a subcutaneous route superficial to the inguinal canal is uncommon and can substantially distort groin and testicular anatomy. We report a 62-year-old man with a remote laparoscopic right inguinal hernia repair who presented with acute pain, nausea, emesis, and a large non-reducible ventral and right inguinoscrotal swelling. Computed tomography demonstrated a midline/right paramedian ventral fascial defect containing small bowel and omentum, with inferior extension toward the right hemiscrotum and inferior displacement of the right testis. Scrotal Doppler ultrasonography confirmed preserved testicular perfusion. Diagnostic laparoscopy was converted to open exploration because of dense adhesions and distorted anatomy. The following two separate defects were identified: a large ventral/incisional defect and a right indirect inguinal defect. The scrotal component originated from the ventral hernia and coursed through a subcutaneous plane superficial to the inguinal canal. The right testis, which had been inferiorly displaced on imaging 48 h earlier, was found in a suprapubic position intraoperatively. The bowel was viable, the testis and spermatic cord structures were preserved, and both defects were repaired. This case emphasizes that complex ventral hernias may violate expected anatomical planes and that preoperative imaging should be integrated with, rather than substituted for, careful operative exploration.