Hydrocele

Reference- Bailey and Love's short practice of Surgery 26th edition

1. Presented by- IBRAHIM KABIR HYDROCELE

2. It is an abnormal collection of serous fluid in a part of the processus vaginalis , usually the tunica vaginalis . DEFINITION

3. CONGENITAL Vaginal Hydrocele- occurs in the space between the two layers of tunica vaginalis . It is the most common variety and the swelling is usually painless. Infantile hydrocele- processus vaginalis is occluded at the deep inguinal ring. Congenital hydrocele- processus vaginalis is patent and connects with the general peritoneal cavity. Encysted hydrocele of the cord- smooth oval swelling associated with spermatic cord. C lassification of Hydrocele

4. Acquired Primary/Idiopathic- cause is unknown Secondary- secondary to the disease of testis and epididymis. Acute or chronic epididymo-orchitis Torsion of the testis Testicular tumor Haematocele

5. By excessive production of fluid within the sac. By defective absorption of fluid. By interference with lymphatic drainage of scrotal structures. By connection with the peritoneal cavity via a patent processus vaginalis (congenital). AETIOLOGY

6. Hydroceles are typically translucent and it is possible to ‘get above the swelling’ on examination of the scrotum. The swelling usually surrounds the testis and epididymis such that they may become impossible to palpate separately . A primary vaginal hydrocele is seen most commonly in middle and later life but can also occur in older children. The condition is particularly common in hot countries. Because the swelling is usually painless it may reach a prodigious size before the patient presents for treatment. The testis may be palpable within a lax hydrocele, but an ultrasound scan is necessary to visualise the testis if the hydrocele sac is tense. CLINICAL FEATURES

7. In congenital hydrocele, the processus vaginalis is patent and connects with the peritoneal cavity. The communication is usually too small to allow herniation of intra-abdominal contents. Pressure on the hydrocele does not always empty it but the hydrocele fluid may drain into the peritoneal cavity when the child is lying down; thus, the hydrocele may be intermittent. Ascites should be considered if the swellings are bilateral Encysted hydrocele of the cord 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.

8. VAGINAL HYDROCELE Lord’s operation: when the sac is reasonably thin walled Jaboulay’s procedure: eversion of the sac with placement of the testis in a pouch prepared by blunt dissection in the fascial planes of the scrotum. INFANTILE HYDROCELE: thin sac should be excised. CONGENITAL HYDROCELE: treated by herniotomy if they do not resolve spontaneously. ENCYSTED HYDROCELE OF THE CORD: excision of the cyst. SECONDARY HYDROCELE: treatment according to the cause. TREATMENT

9. Rupture Haematocele due to spontaneous bleeding into the sac or as result of trauma Herniation of the hydrocele sac through the dartos muscle Atrophy of the testis in long standing cases COMPLICATIONS OF HYDROCELE

10. TRAITS INGUINAL HERNIA HYDROCELE DEFINITION Bulging of part of the contents of the abdominal cavity throygh a weakness in the abdominal wall Abnormal collection of serous fluid in a part of the processus vaginalis , usually the tunica vaginalis SITE Inguinoscrotal Scrotal Get above the swelling Not Possible Possible Reducibility Present Absent Transillumination test Negative Positive Consistency Variable Cystic DIFFERENCE BETWEEN INGUINAL HERNIA AND HYDROCELE