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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 209-210

Concomitant occurrence of inguinal hernia and scrotal varicocele in a diabetic patient: Ultrasonography and doppler evaluation


Department of Radiodiagnosis, JNMC, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Submission15-Jul-2021
Date of Decision28-Jan-2022
Date of Acceptance08-Feb-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Suresh Vasant Phatak
Department of Radiodiagnosis, JNMC, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_273_21

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How to cite this article:
Manoj M, Phatak SV, Ghanta P, Dhawan VB, Gupta R. Concomitant occurrence of inguinal hernia and scrotal varicocele in a diabetic patient: Ultrasonography and doppler evaluation. J Datta Meghe Inst Med Sci Univ 2022;17:209-10

How to cite this URL:
Manoj M, Phatak SV, Ghanta P, Dhawan VB, Gupta R. Concomitant occurrence of inguinal hernia and scrotal varicocele in a diabetic patient: Ultrasonography and doppler evaluation. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 18];17:209-10. Available from: http://www.journaldmims.com/text.asp?2022/17/1/209/352229



Dear Editor,

Inguinal hernia associated with scrotal varicocele is uncommonly seen. We present sonographic and Doppler imaging spectrum in a diabetic patient. A 54-year-old male patient presented with a left inguinoscrotal swelling for 2 years. On clinical examination, an enlarged left scrotum was visualized and its lower part with few dilated vessels can be appreciated [Figure 1]a. Ultrasound examination of the swelling revealed multiple dilated and tortuous vessels within the left scrotal sac. The vessels were seen extending from the upper pole to the lower pole along the lateral aspect of the testis. Color Doppler revealed reversal of flow on Valsalva maneuver, suggesting Grade IV varicocele [Figure 2]. There was also evidence of a left inguinoscrotal hernia with bowel as its contents [Figure 1]b. The concurrent occurrence of inguinal hernia and varicocele has been reported in the literature with an incidence of up to 20%.[1] Their concurrent presence has to be confirmed on imaging as clinical differentiation of the same can be challenging and will affect the outcome and prognosis of the case; hence, it is important. Ultrasound and Doppler play a significant role in diagnosis.
Figure 1: (a) Clinical photogram showing left scrotal swelling with a few dilated vessel on the lower aspect. (b) Gray scale ultrasound image of the left inguinal region reveals herniation of bowel loops into the left scrotal sac

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Figure 2: Gray scale ultrasound image reveals multiple dilated and tortuous venous channels (>3 mm) along the lateral, superior, and inferior aspects of the left testis. Color Doppler reveals reversal of flow on Valsalva maneuver

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Varicocele refers to the dilation of pampiniform venous plexus found within the spermatic cord. It is one of the most common causes of male infertility. Albuz et al. have investigated the role of inguinal hernia in causing secondary varicocele and have suggested the direct compression of the veins by the hernia as a cause for its concomitant presentation.[2] The gold standard in diagnosis and assessment of varicocele is Color Doppler imaging (CDI), which has sensitivity and specificity of nearly 100%.[3] Sarteschi has described five grades of varicocele based on CDI findings.[4]

Ultrasound is a cost-effective and safe imaging modality for the evaluation of inguinal hernias. It has the added advantage of dynamic examination when compared to other modalities. It also plays a crucial role in identifying complications such as strangulation, incarceration, and bowel obstruction. Two types of inguinal hernias have been identified: (1) direct and (2) indirect with contents as either fat or bowel loops.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Holzheimer RG, Schreiber A. Inguinal hernia and concomitant varicocele mimicking mesh complication. Eur J Med Res 2003;8:254-6.  Back to cited text no. 1
    
2.
Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology 2003;227:18-36.  Back to cited text no. 2
    
3.
Albuz Ö, Okcelik S, Ince S, Oğulluk M, Sarıkaya S, Ozan H. Is inguinal hernia a risk factor for varicocele in the young male population. Arch Esp Urol 2019;72:697-704.  Back to cited text no. 3
    
4.
Pauroso S, Di Leo N, Fulle I, Di Segni M, Alessi S, Maggini E. Varicocele: Ultrasonographic assessment in daily clinical practice. Journal of ultrasound. 2011;14:199-204.  Back to cited text no. 4
    
5.
Jamadar DA, Jacobson JA, Morag Y, Girish G, Ebrahim F, Gest T, et al. Sonography of inguinal region hernias. AJR Am J Roentgenol 2006;187:185-90.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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