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HYDROCELE Case Presentation

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8K views27 pages

HYDROCELE Case Presentation

Case presentation

Uploaded by

eshasakri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Hydrocele

C se Present tion
Rno: 60,61,62,63
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Patient Particulars

• Name- Mr XYZ
• Age- 35 years
• Address- Vanasthalipuram
• Occupation- Daily wage labourer
• - Socioeconomic status- Lower middle class according to Modi ed Kuppuswamy
Classi cation (2019)
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Chief Complaint

• Swelling over the left side of scrotum since 1 year


History of Presenting Illness
• The patient was apparently alright 1 year ago when he noticed a swelling on the left side of
scrotum, which was insidious in onset, and initially was about 3x5 cms in size and now has
gradually progressed to the present size.
• The swelling doesn't reduce in size on lying down or increase in size on coughing.
• There is no h/o sudden increase in the size of the swelling.
• - No h/o pain
• - No h/o fever with chills and rigors, burning micturition
• - No h/o trauma
• -No h/o of swelling elsewhere in the body
• -No h/o of sudden weight loss
• -No h/o of STD
Past history

• No h/o similar complaints in the past.


• Not a known case of diabetes, hypertension, tuberculosis, asthma, epilepsy.
• No h/o of any surgeries in the past
Family history

• No h/o of testicular swelling in the family


• No h/o of STD in the family
• No other similar complaints in the family
Personal history

• Diet- Mixed
• Appetite- Good
• Sleep- Sound
• Bowel and bladder movements- Normal and regular
• No addictive habits
Summary

• A 35 year old gentleman who presented with complaints of left sided gradually
progressive painless scrotal swelling since 1 year, not associated with trauma and no
features of recent urinary tract infection.
• Di erential Diagnosis-
1. Hydrocele
2. Epididymal cyst
3. Spermatocele
4. Chronic hematocele
5. Testicular tumor
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EXAMINATION

Patient was examined in the privacy of a well lit room in


standing and supine position after obtaining consent
Patient was exposed from Umbilicus to thigh.
Physical Examination

• Patient is conscious, coherent, cooperative , well oriented to time place and person.
• He is moderately built and well nourished.
• No evidence of pallor, icterus, cyanosis, clubbing, generalised lymphadenopathy
and edema seen.
• Height- 170 cms
• Weight- 65 kgs
• BMI= 22.49 kg/m2
Vitals

• Pulse- 76bpm, regular rhythm, good volume, normal character, normal vessel wall,
no radioradial/radiofemoral delay, all peripheral pulses well felt.
• - RR-16 cycles/ min, abdominothoracic.
• - BP-120/80 mm Hg, in left arm in sitting position.
• Temperature- 98.6°F (Afebrile)
Local examination
Inspection

• Left sided scrotal swelling, measuring about 15×10 cm


• oval in shape, extending from root of penis to base of scrotum
• Skin appear, tense, stretched and shiny with loss of normal rugosity of Scrotum,
prominent subcutaneous veins
• no redness over the swelling
• Penis is deviated to right.
• No increase in size on coughing, doesn’t reduce on lying down
• No scars, no sinuses, no engorged veins
• Right side normal
P lp tion

• All inspectory ndings are con rmed


• Size of left scrotum is about 15×10 cm
• No local rise of temperature or tenderness
• Left sided, scrotal, swelling, oval and shaped, extending from the root of penis to base of
scrotum
• Skin over swelling is stretched and shiny, normality of scrotum is lost
• Smooth surface
• Soft, tense, cystic, consistency
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• Fluctuation test – positive

• Transillumination test – positive


• Able to get above the swelling, spermatic cord is palpable and normal
• Left testes is not palpable separately from the swelling
• Testicular sensation – intact
• Swelling is not reducible
• New impulse/ thrill on, copying or on valsalva maneuver
• Right side – normal
Lymph node Examination

• No palpable inguinal, para aortic and left supraclavicular lymph nodes


SUMMARY

• A 35 year old male patient presented with chief complaints of left sided gradually
progressive painless scrotal swelling since 1 year.
• On examination, the swelling was uctuant, tense cystic in consistency, trans
illuminant, and could get over the swelling.
• This is probably a case of Primary Vaginal Hydrocele.
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https://youtu.be/cGoLhltWL-g?si=3_3OqDwGnYe_XTiM
What is Hydrocele
• A Hydrocele is when abdominal uid lls a sac in the scrotum , causing it to swell.

• A scrotum is the pouch of skin behind your penis that holds the testis

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Types of hydrocele
Congenit l hydrocele

• Here the processus vaginalis remains patent and it freely communicates with the
peritoneal cavity .
• feature - hydrocele gradually disappears when the patient Lies down but returns in
the erect posture .

Prim ry hydrocele

• Seen in middle aged .


• Main complaint is swelling of the scrotum
• “Get above the swelling” if it is a pure hydrocele .
• Not tender whereas secondary hydrocele is tender .
• Dull on percussion
• Testis - impalpable
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Second ry hydrocele

• Occurs secondary to epididymis orchitis , syphilitic a ection of testis


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Investigations
•To confirm diagnosis – usg abdomen and pelvis.
•LABORATORY DIAGNOSIS
1. CBC
2. ESR
3. RBS
4. Blood urea and Serum creatinine
• Pre operative evaluation
1. Chest x- ray
2. ECG
Treatment of hydrocele
• Congenital hydroceles are treated by ligation of the patent processus vaginalis if they
. do not resolve spontaneously.

• Small hydroceles do not need treatment.


• If they are sizeable and bothersome for the patient, then surgical treatment is indicated .
•There are three types of surgeries
1. Plication
2. Eversion
3. Aspiration
• Plication
1. Lords plication is suitable when the sac is reasonably thin walled
2. Here risk of hematoma is reduced

• Eversion
. 1. Jaboulays procedure is in which sac is opened and everted behind the testis with placement
Of the testis ina pouch prepared by dissection in fascial planes

• Aspiration
1. Aspiration of hydrocele fluid is simple but the fluid always reaccumulates
2. It is suitable for men who are unfit for surgery.
3. It can lead to bleeding into the sac and hematocele formation.
THANK YOU

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