Unilateral undescended testis with a contralateral “over-descended testis” present in a left groin interstitial hernia presenting in mid-adulthood

Abstract

Hernia repair remains one of the most common operative procedures performed by general surgeons and herniologists (hernia specialists). Congenital or acquired hernias fall into predictable categories: inguinal, ventral or abdominal, and incisional. Inguinal hernias are the most common accounting for roughly 70% of all hernias. Ventral, abdominal, and incisional hernias are interrelated and their prevalence varies. Other obscure or less common types of hernias include interparietal, obturator, femoral, and interstitial, and their prevalence is around 1%-2% at most. During our operative week, a unique patient presented for evaluation. Until that moment, our team of United States-based adult and pediatric surgeons lacked exceptional first-hand experience with inguinal interstitial hernias. These are generally recognized after previous abdominal wall trauma or surgeries as well as in the setting of congenital defects due to a testis that has not descended. Here, we present a rare case of an inguinal interstitial hernia containing an undescended left testicle that traversed through the internal ring, pivoting lateral and passing parallel to the inguinal canal and into the superficial thigh. Along its course, it traveled through the abdominal wall fascia protruding into the lower extremity, followed by the fascia lata, allowing the testicle and the hernia sac to reside in the left lower extremity thigh anterior compartment.

Keywords

Cryptorchidism / hernia / interstitial hernia / undescended testicle

References

[1] Dabbas N , Adams K , Pearson K , Royle G . Frequency of abdominal wall hernias: Is classical teaching out of date? JRSM Short Rep 2011; 2: 5.

[2] Gillies M , Anthony L , Al-Roubaie A , Rockliff A , Phong J . Trends in incisional and ventral hernia repair: A population analysis from 2001 to 2021. Cureus 2023; 15: e35744.

[3] Iskit SH , Dagli TE , Kiyan G , Durakbasa CU . Interstitial hernia: A diagnostic dilemma in infants and children. J Pediatr Surg 1998; 33: 586- 8.

[4] Glaser J , Pearl J , Wind G , Sheppard F . Laparoscopic repair of a large interstitially incarcerated inguinal hernia. J Surg Case Rep 2011; 2011: 2.

[5] Ulucay KE , Younis MU . Laparoscopic approach to a rare interstitial incisional hernia following appendectomy. J Ayub Med Coll Abbottabad 2017; 29: 344- 6.

[6] Smolilo D , Eteuati J , Hollington P . Acquired interstitial hernia. ANZ J Surg 2017; 87: 305- 6.

[7] Kumar A , Saidha N , Ramakrishnan TS , Sahu S . Interstitial incisional hernia following appendectomy. Med J Armed Forces India 2009; 65: 176- 7.

[8] Ciongradi CI , Sarbu I , Iliescu Halitchi CO , Benchia D , Sarbu K . Fertility of cryptorchid testis-an unsolved mistery. Genes (Basel) 2021; 12: 1894.

[9] Leslie SW , Sajjad H , Villanueva CA . Cryptorchidism. Treasure Island, FL: StatPearls 2024.

[10] Shin J , Jeon GW . Comparison of diagnostic and treatment guidelines for undescended testis. Clin Exp Pediatr 2020; 63: 415- 21.

[11] Lip SZ , Murchison LE , Cullis PS , Govan L , Carachi R . A meta-analysis of the risk of boys with isolated cryptorchidism developing testicular cancer in later life. Arch Dis Child 2013; 98: 20- 6.

[12] Lee PA , Coughlin MT . Fertility after bilateral cryptorchidism. Evaluation by paternity, hormone, and semen data. Horm Res 2001; 55: 28- 32.

[13] Miller KD , Coughlin MT , Lee PA . Fertility after unilateral cryptorchidism. Paternity, time to conception, pretreatment testicular location and size, hormone and sperm parameters. Horm Res 2001; 55: 249- 53.

RIGHTS & PERMISSIONS

International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press