Scrotal enlargement following inguinal herniorrhaphy: ultrasound evaluation

Isolated extratesticular hematoma from intraoperative positioning during lumbar spinal surgery

Scrotal injury is present in less than 1% of all trauma-related injuries. Traumatic injuries of the scrotum are most commonly seen in penetrating or blunt injury but may also occur after iatrogenic causes such as in the intraoperative setting. We report a case of an isolated extratesticular hematoma incurred after scrotal trauma from prone intraoperative positioning during lumbar spinal surgery. Ultrasound performed following the procedure revealed an extratesticular hematoma without evidence of coexisting testicular injury. This case highlights an atypical insult to the scrotum and reinforces the need to ensure adequate positioning to prevent this postoperative complication.

Massive penoscrotal haematoma following inguinal hernia repair: a case report

Introduction

Inguinal hernia is one of the commonest surgical conditions that one comes across in a surgical career. Operative repair is the only successful treatment for hernias. As with other surgical procedures, this is also associated with possible complications. Scrotal haematoma is one of the well-known complications following hernia repair, but massive penoscrotal haematoma requiring surgical intervention is very rare.

Case presentation

A 53-year-old black man had undergone elective hernia repair. He underwent standard open hernia repair with a prolene mesh and developed massive scrotal haematoma which required drainage. Eventually he recovered well, although slowly.

Conclusion

To achieve adequate bleeding control during and at the end of operation is the key preventive measure to avoid scrotal haematoma. Here, we report a case of massive penoscrotal haematoma following repair of a moderate sized inguinal hernia. We strongly emphasize the importance of adequate control of bleeding, even in small to moderate sized inguinal hernias in order to avoid such disastrous complications with long-term cosmetic disfigurement.

Inguinal hernias: MRI and ultrasound

This article presents an overview of the key anatomic structures of the groin region as seen on gross anatomy and the appearance of these structures on ultrasound and magnetic resonance imaging (MRI). An overview of the sonographic and MRI techniques used in preoperative diagnosis of inguinal hernias is provided, and their value is discussed. Finally, the role of ultrasound and MRI after surgical inguinal hernia repair is addressed.

Preoperative and postoperative assessment of laparoscopic inguinal hernia repair by dynamic MRI

RATIONALE AND OBJECTIVES

To determine the value of dynamic MRI for seroma detection, hernia recurrence, and mesh placement in patients after laparoscopic inguinal hernia repair.

METHODS

Thirteen inguinal hernias in 10 consecutive patients were evaluated before and after surgery by using an MRI protocol consisting of coronal T1-weighted (fast field echo) and T2-weighted (turbo spin-echo) images and two sequences obtained during straining (turbo field echo gradient technique). All patients underwent a transabdominal preperitoneal laparoscopic inguinal hernia repair. MRI scans were reviewed for the presence of postoperative fluid collections, recurrent hernia, and mesh localization.

RESULTS

In all patients, an inguinal hernia was identified on the preoperative MRI and was absent on the postoperative MRI. In all patients treated laparoscopically, the mesh and its position were clearly identified. Three small fluid collections were found on the postoperative MRI scans.

CONCLUSIONS

Dynamic MRI can demonstrate small, postoperative fluid collections and a sufficient hernioplasty by showing the proper position of the mesh and the absence of a hernia.

High-resolution ultrasonography in the diagnosis of scrotal pathology: I. Normal scrotum and benign disease

Ultrasonography is a readily accessible imaging modality. It is relatively inexpensive, is noninvasive, and requires no ionizing radiation or previous preparation. For these reasons, ultrasonography is the examination of choice in the study of the scrotum and its contents. We present a review of the pathology of the scrotum and its contents. For that, we cite multiple sources of the current medical literature and illustrate them with cases performed at the University of California Davis Medical Center during the last 2.5 years. Due to the extent of the pathology in consideration, we have divided it in two parts. This article deals with normal ultrasonography anatomy, technique, epididymal and testicular cysts, scrotal calcifications, acute and chronic inflammatory disease, testicular torsion, scrotal trauma, varicocele, undescended testis, and miscellaneous conditions.

Acute scrotum in an infant: post-herniorrhaphy complication. Sonographic evaluation

The complications of herniorrhaphy mainly involve hematoma and other fluid collections within the scrotum. Discussed here is a case of another post-herniorrhaphy complication, recurrent scrotal hernia, in an infant who presented with an acute scrotum and was evaluated sonographically.

Prompt diagnosis of ‘acute groin’ conditions in infants

Urgent sonographic examination of the groin was performed in 58 patients under the age of two years. Accurate diagnosis was done in conditions such as: incarcerated inguinal hernia, twisted undescended testis, incarcerated ovary in inguinal hernia and others. Ultrasonography facilitated decision-making and differentiation between surgical and non-surgical conditions.