Successful treatment for patients with chronic orchialgia following inguinal hernia repair by means of meshoma removal, orchiectomy and triple-neurectomy

被引：4

作者：

Narita, Masato ^{[1
]}

Moriyoshi, Koki ^{[2
]}

Hanada, Keita ^{[1
]}

Matsusue, Ryo ^{[1
]}

Hata, Hiroaki ^{[1
]}

Yamaguchi, Takashi ^{[1
]}

Otani, Tetsushi ^{[1
]}

Ikai, Iwao ^{[1
]}

机构：

[1] Natl Hosp Org, Kyoto Med Ctr, Dept Surg, Fushimi Ku, Kyoto 6128555, Japan

[2] Natl Hosp Org, Kyoto Med Ctr, Dept Pathol, Fushimi Ku, Kyoto 6128555, Japan

来源：

INTERNATIONAL JOURNAL OF SURGERY CASE REPORTS | 2015年 / 16卷

关键词：

Testicular pain; Neuropathic pain; Nociceptive pain; Testicular atrophy; Genital branch of genitofemoral nerve; Ilioinguinal nerve;

D O I：

10.1016/j.ijscr.2015.09.044

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

INTRODUCTION: Orchialgia following inguinal hernia repair is rare complication and still challenging since there has been no established surgical treatment because of complexity of nerve innervation to the testicular area. Herein we report a case of postoperative orchialgia following Lichtenstein repair, which was successfully treated by mesh removal, orchiectomy and triple neurectomy. CASE PRESENTATION: A 65-year-old man was referred to our department because of chronic right orchialgia following Lichtenstein hernia repair. He walked with a limp and was unable to walk a long distance. Physical examination revealed the presence of me shoma in the groin area and hypoesthesia in the anterior skin of the right scrotum. His right testis was completely atrophic and located not in the scrotum but in the subcutaneous regions of right groin. He was diagnosed as both neuropathic and nociceptive orchialgia and underwent meshoma removal, triple-neurectomy, and orchiectomy to address these issues. Pathological examination revealed that meshoma was integrated with the structures of the spermatic cord, leading to foreign-body reaction and fibrosis around the genital branch of genitofemoral nerve. The resected right testis was completely-scarred without ischemic changes. Orchialgia disappeared immediately after operation and he was able to walk without a limp. DISCUSSIONS: It is important to distinguish between nociceptive and neuropathic orchialgia. Neuroanatomic understanding is essential to guide treatment options. Orchiectomy is an option but should be reserved for refractory cases with evidence of nociceptive pain accompanied by anatomical changes. CONCLUSIONS: Triple neurectomy should be considered in patients with neuropathic orchialgia. (C) 2015 The Authors. Published by Elsevier Ltd.

引用

页码：157 / 161

页数：5