A 25 year old man presents with hydrocele on the left side. Associated condition could be a:September 2008
Ans. C: Testicular tumourHydrocele is an abnormal collection of serous fluid in the tunica vaginalis covering the testicles or within some pa of processus vaginalis.Primary/idiopathic hydrocele cause not known (common)Secondary hydrocele secondary to a disease in testis or epididymisEtiologyDefective absorption of fluid by the tunica vaginalisExcessive production of fluid within the sacLymphatic obstructionCommunication with peritoneal cavitySymptomsIn majority - swelling of the scrotum may be the only complaint. Occasionally patient may complain of pain (due to heaviness or complications)Acute hydrocele in a young man may be associated with testicular malignancy.Swelling confined to scrotum (can get above the swelling, cf. inguinal hernia)Fluctuation test positive (cystic swelling)Transillumination test positive (except in thickened, fibrosed and calcified sac)IrreducibleTestis not felt separately (not in secondary hydrocele)ComplicationsInfectionRuptureHaematoceleHernia of the hydrocele sacIn long standing hydrocele (calcification of the sac, atrophy of the testis may be present)Skin excoriation due to in drawing of the penis and dribbling of urine.Decubitus ulcer in the scrotum.TreatmentJaboulay's method of eversion of sac;In this procedure the hydrocele fluid is let out after opening the sac through scrotal incision and then eversion of sac is done so that the secreting surface of the tunica vaginalis turned outsideLord's procedure; in case of small hydrocele and thin sac, plication of the sac is doneExcision of the sac done in case of massive hydrocele with thickened sac.Postoperative ComplicationHematoma - drain asepticallyInfection - treat conservatively/antibiotics after culture and sensitivity, if required.
Nephroma
Hepatic malignancy
Testicular tumour
Penile malignancy