Atypical presentation of a retractile testicle
By Tomas Forde, University College Dublin
Background
A 42-year-old male presented to the emergency department complaining of painful swelling in the right groin for two weeks. In the absence of any previous imaging and normal bloods, a diagnosis of an inguinal hernia
was suspected given the patient's presentation.
Ultrasound Findings
A focused ultrasound of the right groin was performed using a high-frequency transducer. A palpable lump was identified within the right groin. The lump was scanned in longitudinal and transverse using B-mode,
colour Doppler and pulsed wave Doppler. The lump matched the typical sonographic appearances of the right testicle and was located within the right inguinal canal. An ultrasound assessment of the right scrotal
fossa was also performed, which contained the base of the penis. Within the inguinal canal, a defect in the abdominal wall was apparent. The site was scanned using B-mode ultrasound and the Valsalva technique
was implemented with the neck of the inguinal hernia measuring 0.59cm. The hernia enlarged on strain and retracted on relaxation with peristalsis consistent with herniated bowel with the bowel visualised protruding
from the inguinal canal.
Discussion
There is an apparent paucity of information within the literature investigating the relationship between retractile testicles and inguinal hernias in adults. The testicle had been in the inguinal canal for two weeks
which is atypical for a retractile testicle and was suspected of being in the process of becoming an acquired ascending testicle which has complications including testicular cancer, testicular torsion and infertility.
Ultrasound is accurate in the detection and diagnosis of indirect inguinal hernias.
Conclusion
The ultrasound scan findings indicated the presence of a reducible right inguinal hernia as well as a retractile testicle within the inguinal canal. The testicle showed normal sonographic appearances. The patient did not
require any subsequent imaging.