Parent & Patient Information System 06/09/2015 Page7 / 51 Chapter 2 - Hydrocele, Hernia and Undescended Testis Hydrocele and hernia Hydrocele: It is the painless scrotal fluid collection around the testis. Mainly there are 2 types of hydroceles: Communicating: The membrane surrounding the testis is in continuity with the abdominal cavity. The fluid in the abdominal cavity drains into the scrotum via this open connection. This abnormality is also the main underlying pathology for development of hernia. Non-communicating: There is no connection between abdominal cavity and scrotum. This type is mostly seen in adult patients. Testis normally develops in the abdominal cavity and within time migrates downwards into the scrotum. The descent mostly is completed before birth. During its travel, testis sweeps a part of peritoneum (membrane covering the organs in the abdominal cavity) into scrotum that is covering the outer surface of testis. This peritoneal connection between abdominal cavity and scrotum mostly becomes closed before the birth or till the end of the first year of life. In children in whom this connection failed to close, the abdominal fluid can drain into the scrotum by gravity in upright position. This is why the swelling is not so evident in sleeping period but becomes significantly visible in physically active children. If the connection is narrow allowing only passage for fluid, it causes a scrotal swelling which is the finding of fluid collection around testis. Besides this, if the neck of the connection is wider that is allowing the small intestines move forward to scrotum, this is called the hernia. Diagnosis is done by physical examination. The scrotal or inguinoscrotal swelling increasing significantly by crying, abdominal straining is the typical finding. Transillumination method is used to differentiate the hydrocele from hernia. A hand lamp is held beneath the scrotum in a dark room. If the light is clearly seen, it reveals the presence of fluid around testis. If the light is prevented to pass through that means the intestinal segment is present in the scrotum, namely indirect inguinal hernia. In some instances with a doubt in diagnosis, ultrasonography may be helpful.
RkJQdWJsaXNoZXIy NjM1NTk=