DOI: https://doi.org/10.36347/sasjs.2026.v12i11.005

Pages: 919-922

Introduction: Indirect inguinal hernia in males is usually congenital and results from failure of obliteration of the processus vaginalis. Presentation is expected in childhood, and a lifelong, untreated inguinoscrotal hernia diagnosed in an elderly man is uncommon. Case presentation: A 60-year-old man with no medical or surgical history was admitted for a left inguinoscrotal swelling present since birth. Examination revealed a left inguinoscrotal hernia with an estimated neck of 3 cm. After pre-anesthetic assessment, he underwent surgery through a left inguinal incision with opening of the external oblique aponeurosis. Exploration showed an inguinoscrotal hernia classified as Nyhus type IIIb, associated with multiple epididymal cysts and an atrophic left testis, all attributable to a persistent patent processus vaginalis. The sac, which contained omentum, was resected and ligated, a Lichtenstein tension-free mesh repair was performed under spinal anesthesia, and the atrophic testis was preserved. The postoperative course was uneventful and the patient was discharged on postoperative day 1. Discussion: Persistence of the processus vaginalis explains the congenital nature of the hernia, and may be accompanied by hydrocele, cysts of the cord or epididymis, and testicular anomalies. In adults, an atrophic testis found within the sac raises the question of orchiectomy versus preservation, given the risks of malignancy, torsion and infertility attributed to the maldescended or atrophic gonad. Conclusion: In adults operated on for a long-standing inguinoscrotal hernia, the surgeon should systematically assess the testis and the other contents of the sac, and plan the management of the gonad and the posterior wall repair accordingly; a Lichtenstein repair with preservation of the atrophic testis was uneventful in our patient.