Reactive Scrotal Hydrocele Secondary to Hematoma: A Complication of Laparoscopic Transabdominal Preperitoneal Inguinal Hernioplasty-A Report of Two Cases.

Abstract

This case report presents two unique cases of reactive hydrocele formation following transabdominal preperitoneal (TAPP) inguinal hernia repair in adult patients. Although hydrocele development after pediatric inguinal hernia repairs is well-documented, cases in adults are rare and potentially underreported, likely due to the separation of surgical and urological specialties in adult care. Both patients experienced postoperative hematomas within the inguinal region, which resolved initially but subsequently led to symptomatic hydrocele formation over several months. The first patient, a 65-year-old male, developed a left-sided hydrocele with moderate to severe scrotal pain 8 months postoperatively. The second patient, a 70-year-old male, presented with a right-sided hydrocele 4 months after TAPP repair, initially managed conservatively but later requiring further evaluation due to persistent scrotal swelling and tenderness. Both patients underwent ultrasound imaging, which confirmed the presence of fluid collections around the affected testicles, with no abnormalities in testicular blood flow or echogenicity. A conservative management approach was taken in both cases, and symptoms gradually resolved without surgical intervention. These cases illustrate the potential for postoperative hematomas to exert pressure on lymphatic vessels, possibly leading to reactive hydrocele formation. The delayed onset and symptomatology underscore the importance of recognizing hydrocele as a potential delayed complication of laparoscopic inguinal hernia repair in adults. These cases contribute to the limited literature on this topic and suggest the need for larger cohort studies to explore the pathogenesis, prevalence, and potential correlation between postoperative hematomas and hydrocele formation. Awareness of this rarely reported but impactful complication may improve postoperative management and patient outcomes following TAPP procedures.