Differential Diagnosis for a Shrunken Right Testis After Inguinal Hernia Repair

• Single Most Likely Diagnosis
  • D. Testicular artery ligation: This is the most likely cause because during inguinal hernia repair, there is a risk of inadvertently ligating or damaging the testicular artery, which supplies blood to the testis. This can lead to testicular atrophy due to ischemia.
• Other Likely Diagnoses
  • C. Tight external ring of the inguinal canal: A tight external ring can cause venous congestion or arterial compromise, leading to testicular atrophy. This could be a result of the surgical repair itself.
  • B. Thrombosis of the pampiniform plexus: Although less common, thrombosis of the pampiniform plexus (a network of veins surrounding the testicular artery) could lead to venous obstruction and subsequent testicular atrophy.
• Do Not Miss Diagnoses
  • A. Mesh prolapsed into the scrotum: While less likely, mesh prolapse into the scrotum could potentially cause mechanical obstruction or compression of the testicular vessels, leading to atrophy. It's crucial to consider this due to the potential for serious complications if not addressed.
• Rare Diagnoses
  • Other rare causes might include direct trauma to the testis during surgery, infection leading to orchitis and subsequent atrophy, or pre-existing conditions that were exacerbated by the surgery. However, these are less directly related to the common complications of hernia repair.