Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Inguinoscrotal swellings- a problem oriented approach

7 501 vues

Publié le

Inguinoscrotal swellings are common surgical problem. All surgeons should know how to diagnose and manage all these conditions.

Publié dans : Santé & Médecine
  • Identifiez-vous pour voir les commentaires

Inguinoscrotal swellings- a problem oriented approach

  1. 1. INGUINOSCROTAL SWELLINGS A PROBLEM ORIENTED APPROACH
  2. 2. INGUINOSCROTAL SWELLINGS A PROBLEM ORIENTED APPROACH Dr.B.SELVARAJ MS;Mch;FICS; ASSOCIATE PROFESSOR IN PEDIATRIC SURGERY PONDICHERRY INSTITUTE OF MEDICAL SCIENCES PONDICHERRY- 605014; INDIA P I M S
  3. 3. INGUINOSCROTAL SWELLINGS A PROBLEM ORIENTED APPROACH OBJECTIVES Recognise various conditions Clinch correct diagnosis Appropriate investigations Appropriate early treatment Appropriate surgical referral P I M S
  4. 4. INGUINOSCROTAL SWELLINGS Hernia Hydrocele Causes Torsion Testis & Testicular Appendages Epididymo-orchitis Testicular Tumor Inguinal Lymphadenitis P I M S
  5. 5. INGUINAL HERNIA Persistent patent Processus Vaginalis- always indirect Male:Female ratio 9:1 Peak incidence in 1st year of life-common in premies Rt side- 60% Lt side-25% Bilateral-15% P I M S
  6. 6. INGUINAL HERNIA P I M S Inguinal swelling when baby cries Silk glove sign+ Simple hernia reducible Obstructed hernia Not reducible Strangulated hernia Tense Tender Bilious vomiting in obstructed strangulated hernia
  7. 7. INGUINAL HERNIA P I M S
  8. 8. INGUINAL HERNIA- Complications Incarceration – Premature Neonates1yr 50% -- Mature Neonates 1yr 30% -- Mature Neonates 1yr 15% In huge hernia – Testicular atrophy in boys -- Ovarian atrophy in girls Strangulation -- Gangrenous bowel + P I M S
  9. 9. INGUINAL HERNIA P I M S
  10. 10. INGUINAL HERNIA- Operative Management Inguinal skin crease incision Incise External oblique aponeurosis and extend into superficial ring Dissect off hernial sac from cord structures High ligation of sac Herniotomy Close wound in layers P I M S
  11. 11. INGUINAL HERNIA- Operative Management P I M S
  12. 12. INGUINAL HERNIA- Operative Management P I M S
  13. 13. INGUINAL HERNIA-Postop complications Injury to Vas deferens vessels Testicular atrophy due to testicular artery injury Recurrence due to failure of high ligation Wound infection in obstructed strangulated hernia Hydrocele when distal hernial sac around testis hasn’t been left open P I M S
  14. 14. HYDROCELE Peritoneal fluid collection in processus vaginalis Diurnal variation in size Positive fluctuation Transillumination Regression spontaneous closure of processus vaginalis by 1 to 1.5 yrs Get above the swelling+ve Traction test +ve in Encysted Hydrocele Huge Hydrocele Pressure atrophy of Testis P I M S
  15. 15. HERNIAHYDROCELE-Types P I M S
  16. 16. HYDROCELE P I M S
  17. 17. HYDROCELE- Operation High ligation of processus vaginalis- Herniotomy In Encysted Hydrocele in addition incise and evacuate fluid; Don’t close incision P I M S
  18. 18. TORSION TESTIS Twisting of Testis StrangulationNecrosis Common in Neonates at puberty Affects Left side more An Undescended Testis undergoes torsion frequently Swollen hemiscrotum with edema erythema Tender Testis Cremasteric reflex- Absent P I M S
  19. 19. TORSION TESTIS-TYPES In Neonates In Adolescents Very rare P I M S Bell clapper Deformity
  20. 20. TORSION TESTIS P I M S
  21. 21. TORSION TESTIS-Differential Diagnosis Epididymo orchitis Incarcerated Hernia Idiopathic scrotal edema Torsion of Testicular Appendages Hydrocele P I M S
  22. 22. TORSION TESTIS-Doppler Study Central testicular blood flow Normal Testis No Central testicular blood flow but excessive peripheral blood flow P I M S
  23. 23. TORSION TESTIS-Management Ipsilateral sideExploration,Detorsion and Fixation orchiopexy Contralateral side Exploration and Fixation orchiopexy In doubtful cases Nonavailability of Doppler scan Better to explore rather than delay treatment P I M S
  24. 24. Torsion of Testicular Appendages Hydatid of testis epididymisRemnant of obliterated Mullerian ducts Sudden Swelling and redness of hemiscrotum Tender Testis ‘Bluedot sign’ +ve Cremastric reflex intact P I M S
  25. 25. Testicular Appendages P I M S
  26. 26. Torsion of Testicular Appendages Bluedot sign P I M S
  27. 27. Torsion of Testicular Appendages Management Explore Excise torsed appendages In delayed cases 48 hrs conservative treatment with antibiotics P I M S
  28. 28. EPIDIDYMOORCHITIS Inflammation of epididymis Testis due to infection or trauma Sudden onset of pain in a hemiscrotum Commonly associated with UTI Thickened Tender epididymis Pain relief by elevation of hemiscrotum Prehn’s sign Can be treated conservatively with antibiotics and antiinflammatory drugs P I M S
  29. 29. EPIDIDYMOORCHITIS USG Scrotum Thickened Epididymis Reactive Hydrocele Thick Scrotal wall Doppler Scan Excessive blood flow to Epididymis Normal Testicular parenchymal blood flow P I M S
  30. 30. TESTICULAR TUMORS Account for 1% of all pediatric malignant tumors Most are germinal in origin Malignant Present before the age of 3 yrs Endodermal sinus tumor Commonest malignant tumor TeratomaCommonest benign tumor Rhabdomyosarcoma Arise from paratesticular tissues P I M S
  31. 31. TESTICULAR TUMORS Present with painless hard testicular swelling Scrotal skin is usually free Estimation of Alfa-feto-protein Human chorionic gonadotrophin- Tumor markers Needle biopsy- contraindicated High orchidectomy with retroperitoneal lymph node dissection Pot op Radiotherapy or adjuvant chemotherapy P I M S
  32. 32. TESTICULAR TUMORS USG Testis Anterior Hypoechoic areaTesticular Tumor Doppler Scan Hypovascular intratesticular tumor P I M S
  33. 33. TESTICULAR TUMORS High Orchidectomy P I M S
  34. 34. INGUINAL LYMPHADENITIS Look for any primary focus of infection or neoplasia in drainage area – from umbilicus to toes Most are due to reactive hyperplasia and responds to antibiotics Some may be due to Koch’s or Lymphoma In persistent cases always do Excisional Biopsy P I M S

×