Inguinal And Scrotal Swellings And Scrotal Pain


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Inguinal And Scrotal Swellings And Scrotal Pain

  1. 1. Inguinal and Scrotal Swellings and Scrotal pain Robert Shirinov MD
  2. 2. Surgical Problems of Inguinal and Scrotal Region <ul><li>Groin hernias </li></ul><ul><li>Inguinal lymphadenopathy </li></ul><ul><li>Scrotal swellings </li></ul><ul><li>The absent testis </li></ul><ul><li>Testicular pain. </li></ul>
  3. 3. The Nyhus classification of groin hernias: <ul><li>Type1 </li></ul><ul><li>Indirect inguinal hernia with normal internal ring </li></ul><ul><li>Type 2 </li></ul><ul><li>Indirect inguinal hernia with enlarged internal ring </li></ul><ul><li>Type 3 </li></ul><ul><li>Direct inguinal hernia </li></ul><ul><li>Direct and indirect inguinal hernia (Pantaloon hernia) </li></ul><ul><li>Femoral hernia </li></ul><ul><li>Type 4 </li></ul><ul><li>Direct recurrent inguinal hernia </li></ul><ul><li>Indirect recurrent inguinal hernia </li></ul><ul><li>Recurrent femoral hernia </li></ul><ul><li>Combination of type 4a and 4b </li></ul>
  4. 4. Inguinal lymphadenopathy <ul><li>Systemic causes </li></ul><ul><li>Neoplastic </li></ul><ul><ul><li>Hodgkins and non Hodgkins lymphoma (common) </li></ul></ul><ul><ul><li>leukaemia (uncommon). </li></ul></ul><ul><li>Inflammatory </li></ul><ul><ul><li>tuberculosis (uncommon) </li></ul></ul><ul><ul><li>sarcoid (uncommon). </li></ul></ul><ul><li>Local causes </li></ul><ul><li>Infective </li></ul><ul><ul><li>non-specific reactive lymphadenopathy from infection in groin or lower limb (very common). </li></ul></ul><ul><li>Specific infections </li></ul><ul><ul><li>cat scratch fever (very rare) </li></ul></ul><ul><ul><li>lymphogranuloma venereum (very rare). </li></ul></ul><ul><li>Neoplastic </li></ul><ul><ul><li>metastatic disease (from primary lesion in lower limb, external genitalia, perianal region) </li></ul></ul><ul><ul><li>malignant melanoma. </li></ul></ul><ul><li>Inguinal lymphadenopathy demands inspection of the lower limbs (including interdigital clefts and nail beds) and of the perianal region </li></ul>
  5. 5. Scrotal swellings <ul><li>Testicular tumours </li></ul><ul><li>Seminoma and teratoma account for 85% of testicular tumours. </li></ul><ul><li>Seminomas are of lower grade malignancy with 5-year survival rates of 70-90%. </li></ul><ul><li>Teratomas arise from primitive germ cells and may contain elements of bone and cartilage. They characteristically produce the tumour markers alphafetoprotein (AFP) and human chorionic gonadotrophin (HCG). </li></ul><ul><li>Cystic swellings in the scrotum </li></ul><ul><li>Hydrocoele is fluid in the tunica vaginalis. The testis becomes surrounded by fluid and is impalpable. In the elderly hydrocoeles are almost always benign. In young men they may indicate an underlying pathology and demand investigation. </li></ul><ul><li>Epididymal cyst is a fluid filled cyst which may form in any part of the epididymis (head, body or tail). </li></ul><ul><li>Varicocoele is a varicose dilatation of the veins of the pampiniform plexus. It almost always occurs on the left side for reasons that are not clear but probably related to the differing drainage of the spermatic vein - into the renal vein on the left side and directly into the inferior vena cava on the right. </li></ul><ul><li>It is usually likened to palpating ‘a bag of worms, examine the patient lying and standing. </li></ul>
  6. 6. Cystic Scrotal swellings Varicocele Epidydymal Cyst Hydrocele
  7. 7. Absence of a testis from the scrotum <ul><li>retractile testis </li></ul><ul><li>maldescended testis </li></ul><ul><li>ectopic testis. </li></ul><ul><li>Undescended testis </li></ul><ul><li>An undescended testis is one whose normal line of descent from the posterior abdominal wall, through the inguinal canal into the scrotum has been blocked at some point. </li></ul><ul><li>The undescended testis is at increased risk of: </li></ul><ul><li>torsion </li></ul><ul><li>tumour </li></ul><ul><li>trauma </li></ul><ul><li>infertility. </li></ul><ul><li>Ectopic testis </li></ul><ul><li>An ectopic testis is one which has descended normally through the external inguinal ring but then continued along an abnormal line and become lodged in an ectopic position. The commonest positions for an ectopic testis are uperficial inguinal, while perineal, femoral or pre-pubic positions are uncommon. </li></ul>
  8. 8. Acute testicular pain <ul><li>Cremasteric spasm </li></ul><ul><ul><li>This comes as a sharp, transient, ‘lightening’ pain and is said to be associated with stress. </li></ul></ul><ul><li>Acute epididymo-orchitis </li></ul><ul><ul><li>This is an acute pyogenic infection thought to be caused by bacteria from the urinary tract passing retrogradely down the vas deferens. </li></ul></ul><ul><li>Torsion of the testis. </li></ul><ul><ul><li>This is a surgical emergency - delay in surgical treatment may lead to necrosis and loss of the testis. It probably results from a high attachment of the tunica vaginalis to the spermatic cord, which allows the testis to rotate within the tunica (the clapper-bell deformity). </li></ul></ul>
  9. 9. Acute testicular pain