Hernia and abdominal wall: ischaemic orchitis: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hernia and abdominal wall: ischaemic orchitis

Sample item

On the third day after open repair of a large inguinal hernia that extended into the scrotum, a man has a painful, firm, enlarged testis with low-grade fever. The wound is clean with no collection. What is the most likely mechanism?

ATorsion of the cord after mesh fixationBPrimary bacterial orchitis from the woundCThrombosis of the pampiniform venous plexusDDivision of the testicular artery at the deep ring

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Thrombosis of the pampiniform venous plexus

Ischaemic orchitis follows extensive dissection of the cord and a large scrotal sac, causing thrombosis of the pampiniform plexus and venous infarction of the testis. It appears in the first days, and may progress to atrophy. The testicular artery is rarely the cause because of collateral supply from the cremasteric and deferential arteries.

Option by option

A. Torsion of the cord after mesh fixation
Torsion of the cord is not a recognised result of mesh fixation and would present with a high-riding testis.
B. Primary bacterial orchitis from the wound
A clean wound with no collection makes primary bacterial orchitis unlikely.
C. Thrombosis of the pampiniform venous plexus (correct)
Correct. Venous thrombosis of the pampiniform plexus causes a swollen, tender, firm testis within days.
D. Division of the testicular artery at the deep ring
Arterial division is usually tolerated through collateral supply and tends to cause later atrophy rather than acute swelling.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Thrombosis of the pampiniform venous plexus. Ischaemic orchitis follows extensive dissection of the cord and a large scrotal sac, causing thrombosis of the pampiniform plexus and venous infarction of the testis.

Why is "Torsion of the cord after mesh fixation" not the answer?

Torsion of the cord is not a recognised result of mesh fixation and would present with a high-riding testis.

Why is "Primary bacterial orchitis from the wound" not the answer?

A clean wound with no collection makes primary bacterial orchitis unlikely.

Why is "Division of the testicular artery at the deep ring" not the answer?

Arterial division is usually tolerated through collateral supply and tends to cause later atrophy rather than acute swelling.

What concept does this question test?

It tests Hernia and abdominal wall: ischaemic orchitis in General Surgery. It appears in the first days, and may progress to atrophy. The testicular artery is rarely the cause because of collateral supply from the cremasteric and deferential arteries.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hernia and abdominal wall: ischaemic orchitis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.