title: Torsion of an indirect hernia sac: an unusual cause of acute scrotal swelling in children.
abstract: OBJECTIVE
  An indirect inguinal hernia is a common cause of inguinoscrotal swelling in young boys. We describe 3 cases of an extremely unusual entity that has a similar clinical presentation to more commonly diagnosed intrascrotal processes.
  
  
  METHODS
  Two patients presented with acute hemiscrotal enlargement and pain, and a third patient presented with scrotal enlargement only. All patients underwent a scrotal ultrasound evaluation and subsequent inguinoscrotal exploration.
  
  
  RESULTS
  All patients had a multiseptated peritesticular fluid-filled mass on ultrasound evaluation. Subsequent inguinoscrotal exploration revealed a torsion of the indirect hernia sac in each case. A high ligation and excision of the sac was curative.
  
  
  CONCLUSIONS
  Torsion of a hernia sac is an extremely rare entity, and current sonographic imaging fails to clearly diagnose this unusual phenomenon. Because pediatric urologists are commonly called to evaluate a child with an acutely swollen scrotum, awareness of this diagnosis is important.
authors.affiliation: Department of Surgery, Hospital for Sick Children, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Motta
authors.forename: D J
authors.initials: DJ
authors.lastname: Bagli
authors.forename: J V
authors.initials: JV
authors.lastname: Savage
authors.forename: A E
authors.initials: AE
authors.lastname: Khoury
authors.forename: G
authors.initials: G
authors.lastname: McLorie
authors.forename: J P
authors.initials: JP
authors.lastname: Salle
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D005832:Genital Diseases, Male / Q000150:complications / Q000601:surgery; D006552:Hernia, Inguinal / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D012611:Scrotum; D014102:Torsion Abnormality