This document discusses various causes of inguinal-scrotal swellings, including inguinal hernias, hydroceles, undescended testes, and torsion of the testis. Inguinal hernias occur when abdominal contents protrude through the inguinal ring, and can be direct or indirect. Hydroceles are collections of fluid within the tunica vaginalis that cause scrotal swelling. Undescended testes occur when one or both testes fail to descend into the scrotum. Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testis. A thorough clinical examination is required

1. INGUINO-SCROTAL SWELLINGS

2. INTRODUCTION AND ANATOMY
• GROIN -The junctional area (also known as
the inguinal region) between the abdomen
and the thigh on either side of the pubic
bone.

3. CAUSES OF GROIN SWELLINGS
• INGUINAL HERNIA –DIRECT OR INDIRECT
• FEMORAL HERNIA
• UNDESCENDED TESTIS
• INGUINAL LYMPHADENITIS
• LIPOMA OF SPERMATIC CORD
• HYDROCELE
• VARICOCELE
• TORSION OF THE TESTIS
• RETRACTILE TESTIS

4. INGUINO-SCROTAL SWELLINGS
• Acute or chronic
• Congenital or Accquired
Accquired: Traumatic
inflammatory
neoplasm

5. INGUINAL HERNIA
• A hernia is defined as protusion of whole or a
part of a viscus through the wall that contains
it.
• Inguinal hernia comes out through the
superficial inguinal ring

7. Presenting complaints
• Swelling in the inguinal scrotal region.
• Pain- which is mostly dragging type in nature.
• Systemic symptoms-in case of hernia
obstructing the lumen of the bowel cardinal
symptoms of obstruction will appear.
• Other complaints- the cause of the hernia
must be enquired into-increrase in abdominal
pressure conditions.

8. Clinical Examination

9. Differences between Direct and
Indirect hernia

10. Femoral hernia
• A femoral hernia is a protusion of
extraperitoneal tissue, peritroneum and
sometimes abdominal contents through the
femoral canal.

11. Difference between femoral and
inguinal hernia

12. HYDROCELE
• It is the collection of fluid between the two
layers of tunica vaginalis of testis.
• TYPES: Congenital
Accquired which can be primary or
secondary

13. ETIOLOGY
• Defective absorption of fluid by the tunica
vaginalis, probably due to damage to the
endothelial wall by low grade infection.
• Excessive production of fluid as in secondary
hydrocele.
• Interference with drainage of fluid by lymphatic
vessels of the cord.
• Communication with the peritoneal cavity

14. TYPES OF
HYDROCELE

15. Local examination in Hydrocele
• Getting above the swelling
• Transillumination test
• Fluctuant test

16. Difference between hernia and
hydrocele

17. Undescended testis
• Absence of one or both testis in normal
position.
• CAUSES:
Idiopathic.
Harmonal abnormalities-deficiency or
insensitivity to androgens.
Torsion of testis.
Genetic defects-development or function of
gubernaculum.

19. Torsion of testis
• Testicular torsion refers to ttorsion of spermatic
cord structuresand subsequent loss of blood
supply to the ipsilatteral testicle.
• Testicular torsion is primirarly seen in
adolescents and neonates.it is the most
common cause of testicle loss in these age
groups.
• This iss aa urological emergency ,early
diagnosis and treatment are vital in saving the
testicle.

20. pathophysiology
• Torsion occurs as the testicle rotates between
90 and 180 degree compromising blood flow to
anf from the testicle.
• The degree of torsion of testis play avital role in
viability of testis over time.

21. Presentation
• Sudden onset scrotal pain.
• May radiate to lower abdomen
• May have preceding short duration of scrotal
pain
• Associates with nausea and vomitting .
Clinically,
• Testis may appear normal.
• One may lie higher than the other due to cord
shortening.

22. Investigation and treatment
• USG-scrotum, CT , Laproscopy
TREATMENT:
• Target is bring the testis with its blood supply
to the scrotum as early as possible.
• Orchidopexy should be done beyond puberty.
• Testicular prosthesis can be placed in the
scrotum.

24. Epididymo-orchitis
• Inflammation of epididymis and testis due to
infection or trauma .
• Most common age group 20-40yrs.
• In Young- arises secondary to sexually transmitted
genital infection.
• Older- due to urinary tract infection.

25. Presentation and Treatment
• Heavy sensation in testicle area
• Painful scrotal swelling.
• Fever and chills.
• Testicle pain gets worse with pressure.
• Lump in the testicle.
Treatment:
Ceftrioxone 250mg IM /Doxycycline 100mg BD
for 10 days.

27. VARICOCELE
• VARICOCELE: It is a condition in which the
veins of the pampiniform pleus become
dialted and tortous. Left> right .
The impulse on coughing is more like thrill.
On palpation it feels like a bag of worms.

28. OTHER SWELLINGS
• Lymph Varix or Lymphangiectasis- in which the
lymphatic vessels of the cord become dilated
and tortous caused by obstruction due to
filariasis.
• Funiculitis- The inguinal and inginal scrotal
regions will be inflamed and the skin becomes
red, oedematous and shiny. NO CORD
STRUCTURES CAN BE FELT.
• Diffuse lipoma of the cord.
• Inflammatory thickening of the cord.