Omental injury in a hernial sac

Summary A case of unusual findings in scrotal injury in a young boy is presented. CASE REPORT A 14-year-old boy was admitted through the Casualty Department with a scrotal injury. The night before he fell while skating and a friend’s skating boots struck him in the perineum. On examination, there were no abnormal physical signs in the abdomen and the bladder was not palpable. There was no haematuria. The left side of the scrotum was markedly swollen and the swelling extended up to the left inguinal canal. The right side of the scrotum and the right testis were normal. The boy and his mother denied any knowledge of pre-existing inguinal hernia. A clinical diagnosis of testicular haematoma was made. An emergency exploration of the left side of the scrotum was undertaken through a scrotal incision. The testis and spermatic cord were normal. There was a large haematoma, the upper limit of which was pointing towards the inguinal canal. To facilitate exposure, an inguinal incision was then made and the inguinal canal opened. The sac of the left indirect inguinal hernia was found to contain bruised omenturn with bleeding from the omental vessels (Fig. 1). It was obvious that he had sustained an injury to the omentum in a hernial sac. The contused omentum was excised and the hernial sac was removed. The vas and other cord structures were preserved. Bassini’s repair was performed. He made an uneventful recovery. DISCUSSION Early exploration is advised for injury to the scrotum. Injury to the testis is common but damage to other structures has to be borne in mind. A better exposure of all the cord structures is provided by an inguinal approach.