Acute testicular ischemia following manual reduction of inguinoscrotal hernia

Testicular ischemia caused by inguinal hernia repair, and even the presence of the hernia itself, has been recognized in the medical literature, with the latter more commonly in children, but such an event after manual reduction has never been reported before. We present the case of a 67-year-old man who presented to the emergency department with a painful left groin lump. A left inguinoscrotal hernia was diagnosed and reduced “en masse” with manual pressure at the bedside. The patient was discharged but developed acute-onset left scrotal pain as soon as he got home and then re-presented 2 days later with increasing severity of the pain and swelling ever since the hernia reduction. On examination, he was febrile, with a hard, tender, and swollen left testis. Serum inflammatory markers were elevated. Conservative management with intravenous antibiotics and analgesia was commenced. An ultrasound of the testes demonstrated lack of Doppler flow to the left testis, suggestive of acute ischemia. Three days later, there were persistent temperature spikes and significant pain; therefore, the patient underwent an acute left scrotal exploration where a necrotic, black left testis was discovered and excised. He was discharged on the 1(st) postoperative day; histological analysis confirmed testicular infarction.