Even though infected vasitis is rarely reported in the literature, there are other diagnoses that share the same clinical signs, including testicular torsion, epididymo-orchitis, epididymitis, trauma, and incarcerated hernia. A 27-year-old man was brought to the emergency department by his brother with right inguinal and testicular pain for one day. The history was not significant with fever, lower urinary tract symptoms, urethral discharge, change in bowel habits, previous history of inguinal swelling, or surgical intervention. On presentation, the patient was vitally stable, and right infra-inguinal and inguinal vas deferens were tender and swollen; however, both testes and epididymis were normal, and no urethral discharge. Vasitis, or inflammation of the vas deferens, is an uncommon illness that Chan PT and Schlegel classified as either asymptomatic vasitis nodosa or severely painful infectious vasitis. Acute infective vasitis is a really uncommon illness, with only a few occurrences documented in the literature. However, the retrograde transmission of urinary pathogens such as Escherichia coli and Haemophilus influenza is thought to cause acute vasitis. Because of its rarity and ambiguous imaging findings, diagnosing vasitis can be difficult. Epididymitis, orchitis, and testicular torsion can all be ruled out with ultrasound and duplex Doppler screening. Inguinal hernia is difficult to distinguish from vasitis with ultrasound; hence, CT and MRI are more commonly used to confirm the diagnosis. Since this is the first occurrence in our city that we are aware of, it was reported. A few cases from Saudi Arabia have also been documented, and by doing so, we may raise clinicians\' awareness of this disease and ensure that they can treat patients without making an incorrect diagnosis.

Vasitis is inflammation of the vas deferens, which can be divided into acute inflammatory vasitis or chronic vasitis nodosa. Acute vasitis can present with inguinal pain, swelling, or a lump, which could mimic other common pathologies occurring at this site, particularly inguinal hernia. While ultrasound is effective in the diagnosis of epididymitis, orchitis, and hernia, this case illustrates the importance of cross-sectional imaging to establish the correct diagnosis of vasitis, to aid in the prevention of unnecessary surgical exploration and to expedite antibiotic treatment. Previous surgical intervention to the prostate is the leading risk factor for vasitis and should be taken into consideration when making a differential diagnosis and determining which image modality to use. Here, we present a case of vasitis in a 60-year-old male with previous Holmium laser enucleation of the prostate (HoLEP), with an initial diagnosis of inguinal hernia on ultrasound which was later diagnosed as acute vasitis on CT.

Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic vasitis nodosa. Acute vasitis is usually presented with ambiguous clinical findings, and a scan is required for a definitive diagnosis. Retrograde urinary pathogens are typically the cause, and it is treatable conservatively. We present a male in his 40s with a one-day history of right groin pain and a history of right indirect inguinal hernia. On examination, there was an impression of an incarcerated inguinal hernia. A CT scan revealed thickening and inflammatory changes associated with the inguinal canal and a picture of the rare inflammatory condition, acute vasitis. This case report illustrates the significance of understanding the wide range of possible diagnoses associated with acute groin pain and swelling and the importance of imaging in the diagnosis, which might help avoid needless operation.

Inflammation of the vas deferens or what known as acute vasitis is an under-reported condition that usually presents with scrotal or inguinal pain and swelling which can be misdiagnosed and treated as many other conditions. Here, we present one of the first cases to be reported in the literature with bilateral manifestation. A 28-year-old male patient presented complaining of bilateral testicular and inguinal pain associated with inguinal swelling for 3 days. Initially, the patient was being evaluated as a case of incarcerated bilateral inguinal hernia, but with the aid of radiological imaging, the patient was diagnosed correctly and the unnecessary surgical intervention was prevented.

BACKGROUND: Vasitis is a rare condition that may be challenging for the clinical practitioner. Sometimes it is misdiagnosed as incarcerated inguinal hernia; thus, patients end up receiving unnecessary surgery. Compared with the traditional approach with only sonography, the more recent introduction of computed tomography in the diagnostic process has provided higher quality imaging and more detailed anatomy. Consequently, some urologists advocate the efficacy of computed tomography in the differential diagnosis of difficult cases.
METHODS: We present the case of a 23-year-old male who suffered from right inguinal pain and swelling. His scrotum ultrasound showed multiple tubular structure dilatation within the subinguinal area and no testis torsion. The initial diagnosis was a right inguinal hernia. Computed tomography supported that initial diagnosis, and we presumed the lesion represented a herniation of the omentum with mesenteric vessels. Since there was a suspicion of hernia incarceration, the patient underwent diagnostic laparoscopy, which did not reveal herniation, but only erythematous reaction and swelling over the right spermatic cord. Following a final diagnosis of vasitis, he received empirical antibiotic treatment and his symptoms entirely resolved.
CONCLUSIONS: Even though computed tomography can provide thorough imaging of the urogenital system, the contrast enhancement within vessels and inflammatory organs can still be misleading in the diagnostic process.
RéSUMé: CONTEXTE: La déférendite est. une maladie rare qui peut présenter des difficultés pour le praticien. Parfois, elle est. diagnostiquée à tort comme une hernie inguinale incarcérée; ce qui amène les patients à subir une intervention chirurgicale inutile. Par rapport à l’approche traditionnelle avec la seule échographie, l’introduction plus récente de la tomodensitométrie dans le processus diagnostique a fourni une imagerie de meilleure qualité et une anatomie plus détaillée. Par conséquent, certains urologues préconisent l’efficacité de la tomodensitométrie dans le diagnostic différentiel des cas difficiles. PRéSENTATION DU CAS: Nous rapportons le cas d’un homme de 23 ans qui souffrait d’une douleur et d’une tuméfaction inguinales droites. L’échographie du scrotum a montré une dilatation de multiples structures tubulaires dans la région subinguinale, sans torsion du testicule. Le diagnostic initial a été une hernie inguinale droite. La tomodensitométrie a confirmé ce diagnostic initial, et nous avons supposé que la lésion représentait une hernie de l’épiploon avec des vaisseaux mésentériques. Comme il y avait une suspicion d’incarcération de hernie, le patient a subi une laparoscopie diagnostique, qui n’a pas révélé de hernie, mais seulement une réaction érythémateuse et un gonflement du cordon spermatique droit. Après un diagnostic final de déférendite, le patient a reçu un traitement antibiotique empirique et ses symptômes ont été entièrement résolus. CONCLUSIONS: Même si la tomodensitométrie peut fournir une imagerie approfondie du système urogénital, l’amélioration du contraste dans les vaisseaux et les organes inflammatoires peut encore être trompeuse dans le processus diagnostique. MOTS-CLéS: Déférendite hernie inguinale incarcérée tomodensitométrie laparoscopie diagnostique.

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The differential diagnosis of scrotal pain and swelling in adolescent males includes testicular and appendage torsion, epididymitis, epididymo-orchitis, trauma and incarcerated hernia. Physical examination, ultrasound and urinalysis often can identify the etiology of the scrotal pain and swelling. We present a case of left scrotal pain and swelling that was initially concerning for a paratesticular mass. Repeat examination and further imaging during pre-operative assessment was consistent with left-sided vasitis. The diagnosis of vasitis is difficult with ultrasound and commonly requires CT or MRI to differentiate from incarcerated inguinal hernia. Recognition of this uncommonly reported condition may prevent unnecessary surgeries.

BACKGROUND: Vasitis or inflammation of the vas deferens is a rare condition, and few case reports with computed tomography images have been published since 1980.
METHODS: A 50-year-old man presented with severe right inguinal and lower abdominal pain. Initial diagnosis at the emergency department was incarcerated or strangulated inguinal hernia. The computed tomography scan revealed diffuse edematous changes of right spermatic cord and vas deferens with peripheral fat stranding. Correlating with his clinical symptoms, signs, and imaging findings, the diagnosis of vasitis was made. We report a case of acute vasitis about the cause, symptom, pathogen, differential diagnoses, image findings, and treatment.
CONCLUSIONS: Although very rare, vasitis should be listed as one of the differential diagnosis for inguinal mass lesions. Cross-sectional imaging may be necessary to confirm the diagnosis and exclude differentials such as an inguinal hernia. Recognition of the characteristic image findings can help to make the correct diagnosis and avoid unnecessary surgery.

Acute vasitis is a rare infection of the vas deferens. Clinical presentation and disease rarity can cause difficulty in correctly diagnosing this condition. Adjuncts to aid diagnosis can be used that include ultrasound scan (USS) or computed tomography. We report a unique case of acute vasitis following vasectomy, reversal and subsequent re-do vasectomy diagnosed using USS.

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