testicle pain and problems in kids and tiny bit of abdo

Question 1

A 4 year old boy is brought into A+E by his parents as he has started vomiting and is complaining of abdominal pain. The abdominal pain has come intermittently in the past but is now acutely worsening. He does not complain of pain on passing urine.

There is generalised tenderness that is worse on palpation in the inguinal region. On palpation, there is a mass in the right inguinal region.
The cremasteric reflex is present and Prehn’s test is negative. The mass is not reducible and bowel sounds are heard on auscultation over the mass.

What is the most likely diagnosis given this presentation?

Answer 1

strangulated hernia

cremastic reflex( no tightening of the scrotal skin) in testicular torsion is not present and bowel sounds should not be heard

undescended testes asymptomatic lump

acute epididymitis - no relief of pain on elevating the testicles

Question 2

what is a strangulated hernia

Answer 2

A strangulated hernia is a hernia that is cutting off the blood supply to the intestines and tissues in the abdomen. This is an emergency.

Question 3

presentation of strangualted hernia

Answer 3

Abdominal pain
Vomiting
Hernias can have an intermittent history of pain as the hernias are still reducible. Strangulated hernias are problematic as the blood supply to the part of the bowel that forms the hernia is blocked. The bowel that forms the hernia becomes ischaemic and necrotic. This can lead to sepsis and/or perforations.

management is surgery

hernia you would make nil by mouth and list for urgent surgery

Question 3

presentation of strangualted hernia

Answer 3

Abdominal pain
Vomiting
Hernias can have an intermittent history of pain as the hernias are still reducible. Strangulated hernias are problematic as the blood supply to the part of the bowel that forms the hernia is blocked. The bowel that forms the hernia becomes ischaemic and necrotic. This can lead to sepsis and/or perforations.

management is surgery

hernia you would make nil by mouth and list for urgent surgery

Question 4

what is a hydrocele

Answer 4

A hydrocele is a collection of fluid around the testicle.

Question 5

During normal development, the testes develop in the abdomen and descend into the scrotum, usually before birth. The testes descend along the path of the processus vaginalis, which should obliterate. If the processus vaginalis doesn’t completely close, fluid from the abdomen can gradually accumulate in the scrotum, causing a hydrocele.
what is the dx

Answer 5

ultrasound

Question 6

what is the normal management of a hydrocele

Answer 6

Most hydroceles will spontaneously resolve by 12 months. Therefore, management includes observation initially and then surgical correction if they have not resolved by 1 year. This is because there is a significantly increased risk of an indirect inguinal hernia.