Ines Ari, Vito De Blasi
Abscesses adjacent to the vas deferens are exceptionally rare and may clinically and radiologically mimic an incarcerated or recurrent inguinal hernia. We report the case of an 82-year-old man with a history of bilateral inguinal hernia repair, recurrent prostatitis, prostate surgery, and atrial fibrillation who presented with a two-day history of painful, non-reducible left inguinoscrotal swelling. Initial ultrasonography demonstrated a non-reducible fat-containing inguinal lesion with preserved Doppler flow, suggestive of an incarcerated inguinal hernia. Non-contrast computed tomography confirmed a left inguinal fat-containing mass associated with ipsilateral ureterohydronephrosis secondary to distal ureteral stenosis. Because of the strong clinical and radiological suspicion of an incarcerated recurrent inguinal hernia, surgical exploration was undertaken. No recurrent hernia was identified. Instead, a firm necrotic inflammatory mass adjacent to the vas deferens was found and completely excised. Histopathological examination demonstrated acute suppurative inflammation with abscess formation and no evidence of malignancy. Intraoperative cultures grew Enterococcus faecalis, whereas anaerobic cultures remained sterile. The postoperative course was uneventful, with complete clinical recovery and no recurrence during follow-up. This case highlights an important diagnostic pitfall, as inflammatory peri-deferential phlegmon may be misinterpreted as a fat-containing inguinal hernia on imaging. In elderly patients with previous urological disease or recurrent prostatitis presenting with painful groin swelling, uncommon infectious conditions involving the vas deferens or spermatic cord should be considered in the differential diagnosis. Although imaging is essential for the initial assessment, definitive diagnosis often requires surgical exploration together with histopathological and microbiological evaluation.