Bilateral Orchitis and Testicular Enlargement

Introduction/Purpose: The testes develop in the abdominal cavity of the fetus and descend through the processus vaginalis in the abdominal wall before birth. The testis is covered by the tunica albuginea and the tunica vaginalis, and, along with the ductus deferens, testicular artery, pampiniform plexus, and the genitofemoral nerve, are surrounded by the internal spermatic fascia.

Methods or Case Description: During a routine dissections of a 76-year-old male cadaver, bilateral orchitis, bilateral testicular enlargement, a left-sided varicocele, and a right-sided indirect inguinal hernia were discovered.

Outcomes: The right testis was measured at 10 cm and the left testis was measured at 11 cm. Removal of the outer layers of the scrotum revealed solidified green, yellow, and grayish purulent exudate. The left testis was easily compressible and had a large varicocele, while the right testis was turgid and, when dissected, contained a large hematoma. The inferior pole of the left testis had extensive fibrous scarring at the epididymal-testis junction and the anterior surface of left testis had two small nodular plaques protruding from the tunica albuginea. An indirect inguinal hernia was identified within the right spermatic cord. 

Conclusion: If the processus vaginalis does not close completely, this can increase the susceptibility of an indirect hernia occurring. The donor could have had congenital bilateral patent processus vaginalis, which would make him more susceptible to indirect inguinal hernias. Physicians should consider the possibility of unilateral or bilateral patent processus vaginalises when treating patients with a history of indirect inguinal hernias or cryptorchidism.