Torsion of an indirect hernia sac: an unusual cause of acute scrotal swelling in children.
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.
Motta
J
J
Department of Surgery, Hospital for Sick Children, Toronto, Canada.
Bagli
D J
DJ
Savage
J V
JV
Khoury
A E
AE
McLorie
G
G
Salle
J P
JP
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