Differential Diagnosis for a Shrunken Right Testis after Inguinal Hernia Repair

Single Most Likely Diagnosis

• Testicular artery ligation: This is a known complication of inguinal hernia repair, where the testicular artery is inadvertently ligated during the procedure, leading to ischemia and atrophy of the testis. The presentation of a shrunken testis one month post-operatively is consistent with this diagnosis.

Other Likely Diagnoses

• Tight external ring of the inguinal canal: If the external ring is too tight after hernia repair, it can cause compression of the spermatic cord, leading to impaired blood flow to the testis and subsequent atrophy.
• Thrombosis of the pampiniform plexus: This is a possible complication after hernia repair, where a blood clot forms in the pampiniform plexus, a network of veins that drain the testis, leading to ischemia and testicular atrophy.

Do Not Miss Diagnoses

• Mesh prolapsed into the scrotum: Although less likely, this is a serious complication that can cause compression of the spermatic cord and testicular ischemia. It is essential to rule out this diagnosis to prevent further complications.

Rare Diagnoses

• Other rare causes of testicular atrophy, such as testicular torsion or epididymitis, are less likely in this context, given the history of recent hernia repair. However, they should be considered if other diagnoses are ruled out.