A case report of a groin pseudocyst following inguinal hernia repair and a review of the literature

Introduction: Groin hernias are one of the most common general surgery operations performed worldwide and in the United States. We present an exceedingly unusual complication of a patient who underwent a posterior repair of an inguinal hernia. Presentation: A 48-year-old man presented to our hospital with a chronically enlarging left groin mass for five years following a total extraperitoneal repair of a unilateral inguinal hernia. Two separate aspiration interventions led to rapid re-accumulation of the fluid. Physical exam demonstrated a large inguinoscrotal mass in the left groin. It was non-tender and there were no overlying skin changes. His testicles were palpable at the bottom of the scrotum. A computed tomography exam demonstrated evidence of a prior left inguinal hernia repair. The left groin/scrotum had a 12 cm fluid collection with incomplete peripheral calcification, consistent with previous history of seroma. An indirect hernial sac could not be excluded from the diagnosis. During groin exploration an inguinal canal pseudocyst was removed in its entirety without violating the capsule. The patient recovered well; there was no recurrence at a six month follow up. Review of the literature revealed that only two other cases had been reported, but in contrast to our case, the previous cases had an anterior repair for the index operation and the pseudocysts were open and partly resected. Conclusion: Post-operative inguinal pseudocysts are exceedingly rare. Our case is the third reported in the literature. They can develop following open and laparoscopic mesh repair. Surgical intervention is required for definitive management.