Is abdominal fat in the inguinal canal a cause for concern?

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Posted on Mon, 8 Sep 2014 in Abdominal Pain
Question: if there is an intrusion of abdominal fat in the inguinal canal; is it possible that it go into the testicle? What would be the normal route. Where would the fat go; could it go into the main testicle artery and then into the branches of the artery and block the blood flow to some tissue in the testicle? This is sort of like sickle cell anemia when larger than normal hemoglobulin damage the tissue. If this happens do you know of a treatment?
doctor
Answered by Dr. Grzegorz Stanko 1 hour later
Brief Answer:
Detailed below.

Detailed Answer:
Hello!

Thank you for the query.

Well, fat itself can not go to the testicle. Please note that the fat which was seen in the ultrasound is a fat attached to the peritoneum - a membrane which separates and surrounds abdominal cavity. This fat is not long enough to reach the testicle. Such fat is very often visible when inguinal hernia starts. It is usually connected to the peritoneum and pulls it out so the hernia can develop. So it is possible that hernia (build of peritoneum and abdominal organs) will reach the scrotum, but not fat only.
Hernia development is a slow process. It is slow enough to allow skin, scrotum and other tissues to distend and make the place for hernia. So in other words, it will never compress the testicle artery (maybe in extremely rare cases when the hernia is large). So the blood flow is usually not impeded by hernia or fat coming through inguinal canal.
Maybe its not the fat only, but the hernia causing your testicle pain. That is possible. I suggest you to consult a general surgeon as this might need hernia surgery.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 15 hours later
How can you be sure the fat was attached to the peritoneum? They said I had no hernia. Remember I had fat injected into the penis. Is it not possible that the fat traveled through the inguinal canal to the testicles? The radiologist noticed a thickening of the skin surrounding the soft part of the testicle. And since some time; even after a hot bath I cannot see the thin arteries that used to surround the testicle. They are covered with something (like a fat buildup, etc.).
doctor
Answered by Dr. Grzegorz Stanko 7 hours later
Brief Answer:
.

Detailed Answer:
Well, because the fatty tissue must come from abdominal cavity and is very often attached to the peritoneum. There is no other source of fatty tissue in the inguinal canal. Please note that the inguinal canal is build of abdominal muscle tendons. It is very well separated from other tissues so it contains spermatic cord only (in normal conditions). Believe me, when you open inguinal canal there is no fatty tissue inside (in healthy person). The only source of fat in the canal is abdominal cavity. Other soft tissues layers (like fatty tissue located under the skin) are separated from inguinal canal.
So maybe what the radiologist has seen was an inguinal hernia or fatty tissue which can indicate its start.
Fat injection into the penis has nothing to do with inguinal canal or scrotum fat. There is no possibility that the fat from penis can travel through abdominal wall to the inguinal canal and scrotum. Simply penis is located outside the abdominal cavity and has no connection with it.
What you have seen on the scrotum (you call it thin arteries) were nothing more than skin veins. Please note that testicle arteries (every testicle has one) does not surround testicles. Artery gets inside the testicle where it spreads to smaller arteries so the testicle can have sufficient blood supply. Testicle arteries can not be seen from the outside. The only way to see them is either testis surgery or Dopplers ultrasound.
Thickening of the skin is rather caused by some inflammatory process like epidydymis or testicle inflammation. This should be diagnosed and treated by urologist. Please note that if its about testis, it is better to have an ultrasound done by urologist than radiologist.

Hope this will help.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 16 minutes later
I am saying that there is fat in the inguinal canal that came from the penis fat injection (it was a phalloplasty type thing---they do work). They found fat in BOTH canals. But I think I may have overdone it and excess fat started to escape into the inguinal canal. They did also cut the suspensatory ligament which would change the blood flow; and perhaps cause the penis to fall into the inguinal canal. So you know where I am there exists no urologue /radiologist. Unfortunately they are all separate which is part of the problem. The urologists here do not know how to do; or do not even do ultrasounds. I am sure there has been many incidences of fat obstructing the little arteries of the testicles (causing pain) and tissue death; but the radiologists here do not see things very well and do not have enough experience.
doctor
Answered by Dr. Grzegorz Stanko 14 minutes later
Brief Answer:
.

Detailed Answer:
Ok, this is possible indeed. If you are sure that during phalloplasty they injected some part of the fat into the inguinal canal, this is possible source of it. Such fat can cause an inflammation and some scrotum thickening. But it could not be injected into the testicle artery. The needle which is used to the phalloplasty is much larger than the testicular artery is. So it would be really hardly possible to inject anything to the artery with such needle. Moreover the needle which is used to the phalloplasty is a safe needle (called Veress needle). It is very hard to puncture any blood vessel with this needle.
So I`m am really certain that the fat injection to the blood vessel is not the reason of your pain. And there is an easy way to check it. Dopplers ultrasound of testis will show if whole testis are alive or not.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 2 hours later
Okay; see after the first phalloplasty the penis became wider and expanded into the inguinal canal; (this is my theory). After the 2nd injection a small bump developed in the prepuce. So I had a partial circumcision to remove it (perhaps an error). Now the Later on certainly the 3rd injection they did some of penis herniated into inguinal canal. There has been lots of of occasional moderate pain; one doctor thought it was an epydimitis inflammation. But the reality is that I have noticed scrotal thickening. I am concerned that this is effecting the bloodflow; and also temperature of the testicles. How would the fat cause scrotal thickening? Do you think it actually went into the testicle; or is just on the skin of the 'soft part' of the testicle as said the ecograhpy (in 2009).? The comment by the radiologist is consistant with scrotal thickening. And how would the fat get there from the inguinal canal? Wouldn't it have to go into the testicular artery? So you know a couple years after they found the fat in the inguinal canal; and after they found the thickening of the skin of the soft parts of the testicle ; they diagnosed a couple varicocelles. To note these were not there in 2009. Please advise what is causing the thickening of the skin; also is it possible to reverse this condition? And what permanent damage could this have caused?
doctor
Answered by Dr. Grzegorz Stanko 15 hours later
Brief Answer:
.

Detailed Answer:
Here is what most likely has caused scrotum thickening. Our immune system tries to fight everything that is injected to our body, everything that is not on the right place. Fat from our own body injected in the penis, usually does not cause such reaction as it belongs to the host. However, if you inject the same fat into the scrotum and case some bleeding during this procedure, it may result with an inflammation. Inflammation is a process where immune system attacks and tries to eliminate the cause of an inflammation. As a result of an inflammation is a scar tissue (like remains left on the battle field). Such process can cause scrotum thickening. Moreover it may leave a kind of scar so the thickening will be permanent.
But this is only a theory.
If your last ultrasound has been done in 2009, this is a history. You should definitely repeat it and see how it looks right now. If its a scar (should be visible in an ultrasound), you can not reverse it. If its an inflammation, antibiotics and anti-inflammatory medicines should heal it.
If its about permanent damage, hard to tell. However from your description, the main part of testis has been unchanged in 2009. So the main process is rather in the skin or under it. I do not think that the fat went into the testicle, its hardly possible.

To make some conclusions and see how things are now, please have an ultrasound. This will see if there is progression/regression and if any treatment is necessary.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 25 minutes later
I think the fat went from the inguinal canal down into the scrotum skin and attached to the testicle skin. Is this possible? If it went in the testicular artery is it possible that it would go into the little arteries branches that encircle the testicle and then block them or form a buildup in the skin surrounding the testicle?
Or even cause an almost arteriosclerosis of the little artery branches that surround the testicle.
Is it better to an ERM vs an ecography to look for a fat deposit surrounding the testicle (or even inside)?

How would you find evidence of damage to the sertoli and leydig cells? Or atrophy.?
What would this look like on an ecographie? For example would the testicle body image be darker then before?

Even after a bath the skin is thicker and I can almost feel a layer of fat between the skin and testicle body.

doctor
Answered by Dr. Grzegorz Stanko 2 hours later
Brief Answer:
.

Detailed Answer:
Yes, it is possible that fat from inguinal canal could get to the scrotum due to gravity. But its impossible for it to get to the artery. No doubt in that. The only way to make the fat present in the artery is to inject it precisely to it. And even if it would block the artery, your testis could get dead (whole or part of it). So you would get testicle pain in the first hours/days after such injection and after it that time redness, warmness in the scrotum.
Ultrasound is very good in testis visualization so no need to do more precise test like CT or MRI.
Damage of testis cells should give decreased sperm count. Sperm test should be done.
Atrophy can be seen in the ultrasound. It would give no sign in Dopplers ultrasound. Testis would be smaller.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko 3 hours later
Okay. If the fat goes into the scrotum by gravity could it cause atrophy and pain? I fear that the fat in the penis has been slowly metabolising (over the years) and somehow got into the inguinal canal; and the testicular artery. If there was a little tear in the testicular artery or tissue near it could the fat sneak in through there? I am very sure the doctor did not inject fat into the artery and I did not experience pain immediately after any injection. There was a delay of at least one month. Maybe it has something to do with a changed angle of artery flow between the penis; testicles and body. IF part of the testis died would it have to be removed or would it perhaps hurt and shrink? I have many times redness, warmness and heaviness in scrotum. Sometimes I can't even wear underwear. Also since 2006 if I smoked a cigarette; or ate fatty food my testicles would hurt. Problem started in 2006. Before I was fine; I never had a single pain in my testicles; they were free; never a cause for concern. I became very concerned starting in 2012/13 when after a bath I could no longer see the little arteries over the testicle capsule. I think they are covered by fat (like chicken skin). It is sometimes the left one; then sometimes the right one that hurts. It is painful and has been impacting sports. I have had 6 ultrasounds since 2006 and they always say I am fine. I have been to the Emergency room at least 4 times; I have seen several urologists; they all tell me I am fine. But my testicles are now smaller than normal (on ultrasound only 3.4 to 3.7 cm; the right one had been a bit larger but this trend has changed; oddly after the first big pains in 2006 the testicles were both measured as only 2.95cm. long). I will say that when I take a bath the testis become noticeably larger. Something has messed with them and the blood flow. I know before all this they were AT LEAST 4.4cm tall. It is something like they have gone from 18ML to 12ML each.
My sperm count in Sept 2012 was 50 million /ML total 180 million; but the forward mobility was only 35%. My bioavailable testosterone has been from 0.42 to
0.74 Ng/ML during 2011 to recently; there is no real order of progression; but the normal is 1 to 3.5.

In 2012 the blood flow of the main arteries were 10.5cm/s (right side) resistance index as 0.77. Left side resistance index was 0.83 with a flow of 12.3cm/s. Last month the right artery had a flow of 11.5 cm/s with a resistance of 0.536. I have had a few ultrasound taken including one which shows color doplar flow to the testis. There are some dots of color (orange and blue) over the capsule ; but not in all places. Could I send these to you by scan? In 2012 they started to notice varicelle (left) and then in 2014 also on the right side. In 2009 they stated no varicocelles and no hernia; even though they noticed fat in the inguinal canals.
But I think recently the varicocelles are almost gone.
If there was dead tissue is it possible that I not be aware of it? How could one restore normal blood flow to testicles? How to remove the fat? Could one inject something into the testicule artery? I appreciate your help as this is a very difficult problem to solve.
I have an US from 2006 with report; from 2009 but only the report; then 2012 only report; and then 3 from this year. They did notice an epydimal cyst of 3mm on the epdimis of left testicle and has been there since 2012; it has not gone away.
doctor
Answered by Dr. Grzegorz Stanko 22 hours later
Brief Answer:
.

Detailed Answer:

1. If the fat has not been injected into the testicular artery on purpose, there is no other possibility for the fat to get inside it. So the theory about fat in the artery is wrong for sure. So please stop thinking about such possibility. There is also no artery tear possibility. This would cause bleeding.
2. Fat in the scrotum can cause pain and skin thickening. But the symptoms would appear days/week after an injection. For sure not after such long time.
3. If the part of testis died due to impeded blood flow, it would have to be removed. Otherwise, you would get pain, redness, warmness and fever. Tissues necrosis would cause general illness. So your symptoms are rather not caused by testis necrosis.
4. Your testis can get smaller due to some hormonal problems. I can see you have had some testosterone injections. Please note that such injections can block testis function and make them smaller.
5. In Dopplers ultrasound we can observe the blood flow. Dpeending of the blood flow direction (to the probe or from the probe) it is marked as blue and red. Other small dots visible in some places are negligible.
6. Varicocele can not disappear by itself. Once they appear, without surgery they wont be gone. So this might be the main reason of your pain.
7 Once the blood flow to the testicle is compromised, you ca not restore it.

Hope this is a complete answer.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5768 Questions

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