Gangrenous appendix epididymis following bilateral open inguinal hernia repair: A rare case report

Appendix epididymis necrosis is an exceptionally rare complication following inguinal hernia repair, with limited cases documented in the literature. The appendix epididymis, a mesonephric duct remnant, is prone to ischemia due to its pedunculated structure and delicate vascular supply. Although complications such as testicular ischemia are uncommon after hernia surgery, this case highlights the multifactorial etiologies, including inflammation and venous congestion, that can lead to such outcomes. Early recognition and prompt intervention are critical to prevent morbidity and optimize patient outcomes. A 42-year-old male with a four-year history of progressive bilateral inguinal swelling underwent bilateral open mesh repair for inguinal hernia. The surgery was uneventful; however, on postoperative day three, the patient developed severe right scrotal pain, swelling and tenderness. Scrotal ultrasound revealed absent arterial flow to the right testis, heterogeneous parenchyma, and a septated fluid collection. Surgical exploration identified a gangrenous appendix epididymis with associated testicular changes, necessitating right orchiectomy. Despite the absence of torsion or significant spermatic cord abnormalities, ischemic changes progressed, emphasizing the multifactorial etiology of this rare complication. This case emphasizes the importance of early recognition and management of rare complications (post- hernia repair) such as appendix epididymis necrosis. Correlation of clinical symptoms with Doppler imaging and laboratory markers was pivotal in guiding timely intervention. Surgeons should maintain a high index of suspicion for such complications in patients presenting with acute scrotal pain and swelling after hernia repair. Future research is needed to explore the pathophysiology of these complications and refine surgical and postoperative monitoring protocols.