Please forward this error screen to 193. Please forward this error screen to sharedip-1071801236. Communicating hydrocele, caused by the failure of the processus vaginalis closure. A atlas of clinical diagnosis pdf is an accumulation of serous fluid in a body cavity.
A hydrocele testis is the accumulation of fluids around a testicle. The swelling is soft and non-tender, large in size on examination, and the testis cannot usually be felt. The presence of fluid is demonstrated by trans illumination. These hydrocoeles can reach a huge size, containing large amount of fluid, as these are painless and are often ignored. They are otherwise asymptomatic, other than size and weight, causing inconvenience. The tunica and the processus vaginalis are distended to the inguinal ring but there is no connection with the peritoneal cavity. Getting above swelling is not possible.
The processus vaginalis is patent and connects with the general peritoneal cavity. The communication is usually too small to allow herniation of intra-abdominal contents. Digital pressure on the hydrocele does not usually empty it, but the hydrocele fluid may drain into the peritoneal cavity when the child is lying down. There is a smooth oval swelling near the spermatic cord which is liable to be mistaken for an inguinal hernia. The swelling moves downwards and becomes less mobile if the testis is pulled gently downwards. Rarely, a hydrocoele develops in a remnant of the processus vaginalis somewhere along the course of the spermatic cord. This hydrocoele also transilluminates, and is known as an encysted hydrocoele of the cord.
The accuracy of the diagnosis must be ascertained. Great care must be taken to differentiate a hydrocele from a scrotal hernia or tumor of the testicle. Ultrasound imaging can be very useful in these cases. A hernia usually can be reduced, transmits a cough impulse, and is not translucent.
A hydrocele cannot be reduced into the inguinal canal and gives no impulse on coughing unless a hernia is also present. Most hydroceles appearing in the first year of life seldom require treatment as they resolve without treatment. Hydroceles that persist after the first year or occur later in life require treatment through open operation for removing surgically, as these may have little tendency towards regression. The scrotum should be supported post-operatively and ice bags should be placed to soothe pain. Regular changes of surgical dressings, observation of drainage, and looking for other complications may be necessary to prevent re-operation. After aspiration of a primary hydrocoele, fluid reaccumulates over the following months and periodic aspiration or operation is needed.
For younger patients, operation is usually preferred, whereas the elderly or unfit can have aspirations repeated whenever the hydrocoele becomes uncomfortably large. Rupture usually occurs as a result of trauma but may be spontaneous. On rare occasions cure results after the fluid has been absorbed. Herniation of the hydrocele sac through the dartos muscle sometimes occurs in long-standing cases. Transformation into a haematocele occurs if there is spontaneous bleeding into the sac or as a result of trauma. Acute haemorrhage into the tunica vaginalis sometimes results from testicular trauma and it may be difficult without exploration to decide whether the testis has been ruptured.
If the haematocele is not drained, a clotted haematocele usually results. Clotted hydrocele may result from a slow spontaneous ooze of blood into the tunica vaginalis. It is usually painless and by the time the patient seeks help, it may be difficult to be sure that the swelling is not due to a testicular tumour. Indeed, a tumour may present as a haematocele. Occasionally, severe infection can be introduced by aspiration. Simple aspiration, however, often may be used as a temporary measure in those cases where surgery is contraindicated or must be postponed.
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