Inguinoscrotal Swellings Flashcards
What are the different causes of an inguinal swelling?
- hernia
- lipoma of the cord
- LN enlargement
- Subcutaneous swelling
- aneurysm of vessels
- undescended testis
What are the causes of inguinoscrotal swellings?
- hernia
- varicocele
- hydrocele
- lipoma of cord
DD of scrotal swelling?
- Testicular tumor
- hydrocele
- epididimo-orchitis
- epididimal cyst
The dilation and tortuosity of the pampiniform plexus is caused by what disorder?
Varicocele
Varicocele is more common in who and where?
- more common in tall thin young men
- more common on the left side
What is the common complication of varicocele?
due to increased temperature in scrotum which depresses spermatogenesis and leads to correctable infertility
What are the types of varicocele?
- primary/idiopathic 95% (incompetence in valves of testicular vein)
- secondary: left sided renal complication or retro-peritoneal mass
Why is varicocele more common on the left side?
- left testicular vein joins left renal vein at right angle
- liable to get compressed by loaded sigmoid
- left renal vein is compressed between aorta and superior mesenteric artery (NUTCRACKER)
What are the clinical features of varicocele?
- dragging pain in testis aggravated by standing & relieved by lying down
- impaired sperm quality
- cosmetic attention
- swelling in scrotum
- failure of affected testis to grow
How should a varicocele patient be examined?
- warm room standing & lying down with and without valsalva maneuver
You feel a painless compressible mass with a feeling of bag of worms and a thrill and a testis smaller than the other. What should be your diagnosis?
Varicocele
What investigations should be done for a varicocele patient?
- venous doppler of scrotum and groin (to check if there is reflux and to know what grade)
- U/S of the abdomen to see if there’s a secondary cause
- semen analysis (MEDICO-LEGAL)
What are the complications of a varicocele?
- Male infertility
- testicular atrophy
When should intervention occur to reverse a varicocele?
- SYMPTOMATIC
- impaired sperm quality
- dragging pain
- cosmetic
- MEDICALLY UNFIT for army
What it the best approach to ligate the pampiniform plexus?
inguinal approach
What are the complications of pampiniform ligation?
- hydrocele formation due to ligation of lymphatics
- recurrence
- testicular infarction
- infection & hemorrhage
What disorder would be caused if the processus vaginalis was not completely obliterated?
hydrocele: collection of fluid between the 2 layers of tunica vaginalis
What are the causes of hydrocele?
- congenital
- acquired
- defective absorption from processus vaginalis
- excess production of fluid
- impaired lymphatic drainage
- communication with peritoneal cavity
What are the types of hydrocele?
Primary Vaginal Hydrocele
- fluctuant
- transilluminant (clear serous)
- testis is not palpable
- can get above swelling
Infantile hydrocele
- tunica and processus vaginalis are distended up to internal ring
- no connection to peritoneal cavity
- in the morning like the night (no change in size)
- conserve for 1 year
Congenital hydrocele
- communication between processus vaginalis and peritoneal cavity
- in the morning is a different size than the evening
- can not be emptied by pressure (inverted ink bottle)
Encysted hydrocele
- part of the processus vaginalis is open
- smooth oval swelling associated with spermatic cord
- on traction becomes less mobile
Hydrocele-en-bisac (bilocular hydrocele)
- 2 intercommunicating sacs one above and on ebelow neck of scrotum
Hydrocele of the canal of Nuck
- in females in relation with the round ligament
- always in inguinal canal
Hydrocele of hernial sac
- due to adhesions of content of hernial sac
What are the causes of a secondary hydrocele?
Infection
- filariasis
- Tuberculosis of epididymis
- Syphilis
Injury
- trauma
- post herniorrhaphy (due to tightening of internal ring)
Tumor
- malignancy secondary hydrocele
(small lax and testis is palpable except filariasis can be very large)
What are the complications of hydrocele?
- infection
- pyocele
- haematocele
- atrophy of testis (long standing)
- infertility
How is hydrocele treated?
SURGERY
- sub-total
- partial excision and eversion
- evacuation & eversion
- Lord’s plication (stitch on tunica vaginalis to limit its growth)
Congenital swelling that feels like a bunch of tiny grapes (multilocular) and is brilliantly transilluminant appearing like Chinese lanterns is called?
Cyst of epididimis
How to manage the cyst of epididimis?
AVOID EXCISION because it can result in infertility
What is a unilocular, acquired retention cyst derived from blockage of a portion of sperm conducting mechanism of epididymis?
Spermatocele
Where is the location of a spermatocele?
in the head of the epididymis above and behind the body of the testis
What are the contents of a spermatocele swelling?
- barley water like fluid containing spermatozoa
- soft cystic and transilluminant (described as a 3rd testis)
What is the difference between an epididymal cyst & a spermatocele?
EPIDIDYMAL CYST SPERMATOCELE
- congenital - acquired
- behind body of testis - behind and above testis
- multilocular - unilocular
- bunch of grapes appearance - 3rd testis
- clear fluid - barley water fluid
containing spermatozoa
- brilliantly transilluminant - transilluminant
- excision avoided in young - can be excised
What are the acute scrotal swellings?
- torsion testis (always first)
- epididymo-orchitis
- hernia
- trauma
- dermatological
What is the true surgical emergency of the highest order?
testicular torsion
- irreversible ischemic injury begins 4 hours after occlusion
- intravaginal torsion results from lack of normal fixation
- abnormally mobile testis that hangs freely in tunical space
what is the commonest age for testicular torsion?
prepubertal males
How does a patient present with testicular torsion?
Pain Nausea Vomiting poor appetite previous episodes tender swelling high riding transverse orientation loss of cremasteric reflex
How to treat testicular torsion?
doppler US to confirm diagnosis
scrotal exploration
detorte the affected testis and PEX THE OTHER SIDE while waiting for the testis to pink up
if testis is not alive do orchiectomy
