Transcript
ANTHONY GABRIAL.SIndira Gandhi Medical College & Research InstitutePondicherry
CONGENITAL VAGINAL
HYDROCELE
A case report
INTRODUCTIONDefinition: Is a collection of fluid
within the tunica vaginalis of the testis.
Common in newborns.
Most hydroceles disappear without treatment within the 18 months of life.
Usually unilateral, but can also occur bilatarally
Hydrocele normally is seen in infant boys - as enlarged
scrotum. in infant girls - as enlarged
labia.Hydrocele boys > girls. There is a greater chance of
infertility if the hydrocele does not show itself until the child has reached adulthood.
MATERIALS & METHODSA 4 years old boy was referred to the
pediatric OPD with swelling of right scrotum since birth.
The mother complained of swelling of right scrotum, which increased in size gradually.
No h/o pain.There was no h/o decresing in size of
swelling on lying position.No h/o increase in size with swelling
on coughing.
ON EXAMINATIONSkin and subcutaneous tissue:
Tense, normal rugosity of the skin lost.
Impulse on coughing: NegativeFluctuation: PositiveTransillumination test: PositiveReducibility: Positive.Testis- can be palpated posteriorlyLymph nodes- Not palpableLeft scrotum was normal.USG : Done for right scrotum
On examination, It was identified as COMMUNICATING HYDROCELE.
It was diagnosed as CONGENITAL RIGHT SIDED VAGINAL HYDROCELE & surgical correction of the hydrocele was done.
DISCUSSIONCONGENITAL VAGINAL HYDROCELE
Fluid-filled sac surrounding a testicle
swelling of the scrotum
Presented as loose bag of skin underneath the penis.
As the testesdescends it carries alongwith it a double layeredPeritoneal sac – PROCESSUS
VAGINALIS. Later on the distalportion of processusvaginalis alone persistsas TUNICA VAGINALIS.Proximal portionobliterates.
DEVELOPMENT
Congenital vaginal hydrocele results when the processus vaginalis remains patent, allowing fluid from the peritoneum to accumulate in the scrotum.
INCIDENCE30% in the infant boys
◦(8% - 33%)10% in the infant girls
◦(6% - 15%)40% in aldults
◦(19% - 41%)58% - 93% right sided<10% left sidedFew are bilateral
SURGICAL TREATMENTMostly resolve with medical treatment. If discomfort or very large, two methods
of treatment are available a) aspiration and b) hydrocelectomy (surgery).
WITHOUT SURGERY
ASPIRATION
HYDROLE-CETOMY
ASPIRATIONNeedle is used to drain the fluid. Not common treatment for
hydroceles, but performed when surgery is too risky.
Complication: FIBROSIS
Hydrocelectomy Minor surgical procedure where fluid is
drained.Under anesthesia, through a small
incision, fluid is drained and while stitching, the tunica vaginalis is everted and stitched.
Here the proximal part is also cut and stitched.
Complications: blood clot, infection & injury to scrotum
COMPLICATIONSInfertilityTesticular atrophy.Haematoma.Excessive scar formation.Recurrence of the hydrocele after
inguinal approaches.
CONCLUSIONHydrocele is a differential diagnosis in
males commonly presenting with an enlarged scrotum.
Hydroceletomy is done & tunica vaginalis is everted &stitched.
Proximal part extending into inguinal region is also stitched in its proximal portion.
Most commonly seen in boys than girls.Congenital communicating hydrocele is
accompanied with hernia and so a search on hernia with hydrocele should be ruled out.
BIBLIOGRAPHYScrotal swelling : NICE, CKS, Feb 2010.Aspiration versus hydrocelectomy for the
treatment of hydroceles.Rudkin SE et al, Hydrocele in emergency
medicineClinical hydrocele : A Manual Method Of
Surgeey, S.DASHydrocele swelling : net source
WikipediaHydrocele overview : Mayo Clinic Kogan BA. Communicating hydrocele/hernia repair in
children. BJU Int 2007;100:703-13
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