Cryptorchidism and Small Bowel Obstruction, An Incidental Finding During Incarcerated Inguinal Hernia Repair

Introduction/Purpose: Cryptorchidism is a common congenital abnormality. An undescended testicle should be repaired by six months of age. One of the main risks of leaving an undescended testicle is  malignancy. Here we present a case of a 65 year old male with an undescended testicle that presented with incarcerated right inguinal hernia causing SBO.

Methods or Case Description: We present a case of a 65 year old male with PMH of right sided undescended testicle who presented to the emergency room with an incarcerated right inguinal hernia. Upon exam the patient had a right incarcerated inguinal hernias, the right side was tender to palpation. It was also noted that the patient only a left testicle. The patient was taken to the operating room for a right inguinal hernia repair and the contents of the hernia included viable small bowel and an undescended right testicle. Inguinal hernia was repaired with mesh and orchiectomy was performed.

Outcomes: Hernia sac and testicle was sent for pathology. The pathology of the testicle was found to be benign and patient was discharged on POD 1.

Conclusion: Cryptorchordism is a common congenital abnormality that is seen in young males, but is rare in adults. The relative risk of neoplastic changes in undescended testes is 40 times higher. After puberty the loss of functionality, and fertility rates do not improve after postpubertal repair this orchiectomy. After orchiectomy, repair should be performed by completely closing the inguinal canal after hernia defect is repair. Mesh and inguinal canal no longer need a channel for cord structures since they have been removed. This is an interesting case that is not readily encountered but one should know how to manage if encountered intraoperatively.