Omental fibroma combined with right indirect inguinal hernia masquerades as a scrotal tumor: A case report

Abstract

BACKGROUND

The most common causes of scrotal enlargement in patients include primary tumor of the scrotum, inflammation, hydrocele of the tunica vaginalis, and indirect inguinal hernia; scrotal enlargement caused by external tumors of the scrotum is rare. The patient had both a greater omentum tumor and an inguinal hernia, and the tumor protruded into the scrotum through the hernia sac, which is even rarer. Moreover, omental tumors are mostly metastatic, and primary omental fibroma is rare.

CASE SUMMARY

Here, we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months. Preoperative examination and multidisciplinary discussions considered intra-abdominal tumor displacement and inguinal hernia, and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum. Therefore, tumor resection and tension-free inguinal hernia repair were performed. The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.

CONCLUSION

This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking, physical examination, and imaging before surgery.

Keywords: Hernia; Indirect inguinal hernia; Fibroma; Omental tumor; Scrotal tumor; Greater omentum; Case report

Core Tip: Intrascrotal tumors are common male reproductive system-related tumors and are mostly primary tumors. In this case, the tumor in the scrotum of the patient was not a primary tumor of the scrotum or a metastatic lesion of other tumors. Instead, a primary lesion of the greater omentum fibroma in the abdominal cavity was completely displaced to the scrotum, which is a rare occurrence. We searched the studies included in PubMed since 2011 and found four similar reports of fibromas herniating into the scrotum, originating from the greater omentum, mesentery, and appendix. Analysis showed that the patients’ tumor activity was high, and all patients also had an inguinal hernia, which was the basis of the disease. This case reminds us that even the most common diseases may have various unexpected situations, and it is necessary to conduct detailed inquiries and physical examinations on the patient and complete relevant preoperative examinations and tests to avoid misdiagnosis. When the patient's condition is complex, multidisciplinary joint diagnosis and treatment are needed to choose the most suitable treatment method.