IS Case 190: Scrotal hernia with testicular torsion

Sara Ann Majewski, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-22


Patient is a 23-year-old male with history of right inguinal hernia and right testicular pain and bulge.


Right testicular torsion and right inguinal hernia containing bowel.


Scrotal hernia with testicular torsion


Inguinal hernias are the most common abdominal wall hernia. They are seen with higher frequency in males.

Direct inguinal hernias are seen in the Hesselbach triangle, the boundaries of which are the inguinal ligament, inferior epigastric artery, internal oblique aponeuroses and transversus abdominus muscles. These hernias are medial to the inferior epigastric vessels and tend to occur in adults.

Indirect inguinal hernias are due to failure of obliteration of the patent processus vaginalis. They are lateral to the inferior inguinal vessels, originate at the deep inguinal ring and are most common in children.

Scrotal hernia is seen as a paratesticular mass. They are typically diagnosed by history and physical. The hernia can be composed of small or large bowel and/or fatty omentum. Valvulae conniventes in small bowel, haustra in large bowel and peristalsis are present. Differential diagnosis includes entities such as hematoceles or pyoceles in the absence of these features.

For a discussion of testicular torsion, please see case 170.


  1. Dahnert WF. Radiology Review Manual. 6th ed. Wolters Kluwer / Lippincott Williams & Wilkins: New York, 2007.
  2. Rumack CM, Wilson SR, Johnson J-A, Charboneau JW (eds). Diagnostic Ultrasound, 3rd. ed., Elsevier Health Sciences, 2005.

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