Hydrocele in children

BY DR. ALI NOUFAL ALKHALAF

ANATOMY OF SCROTAL

Scrotum;can be considered as an
outpouching of the lower part of the
anterior abdominal wall.it contains the
Testis,Epididymides,lower end of
spermatic cord
 The wall of scrotum has the
;following layers
skin-1 •
superficial fascia-2 •
external spermatic fascia derived from-3 •
the external oblique
cremasteric muscle derived from the-4 •
internal oblique
internal spermatic fascia derived from -5 •
the fascia transversalis
tunica vaginalis-6 •
HYDROCELE •
Types •
Congenital •
Acquired •
 Testis
The testis is a firm mobile organ lying within the •
scrotum.Each testis is surrounded by atough
fibrous capsule the tunica albuginea
Extending from the inner surface of the capsule •
is a series of fibrous septa that divide the interior
of the organ into lobules.lying within each lobule
are one to three coiled tubules open into a
network of channels called the rete testis.the
efferent ductules connect the rete to upper end
of epididymis
 Causes of scrotal swelling
hyrocele-1 •
indirect inguinal hernia-2 •
varicocele-3 •
epididymal cyst-4 •
epididymo-orchitis-5 •
testicular tumor-6 •
haematocele-7 •
torsion of testis-9 •
sebaceous cyst-10 •
 ;DEFINTION OF Hydrocele
Collection of abnormal quantity of serous
fluid in the tunica vaginalis.If it contains
pus or blood it is called pyocele or
haematocele
.Hydrocele is more common than the two
other varieties.
 TYPES OF HYDROCELE
;PRIMARY TYPE •
primary;cause unknown associate with-1 •
.patency of proccessus vaginalis
;It classified as follows •

communicating;it connect with the-1 –

.peritoneal cavity
noncommunicating;it dose not connect with-2 –
.peritoneal cavity
 ……CON
2- secondary; where the fluid accumulate
secondary to pathology inside the testis
like epididymo-orchitis,testicular tumor and
trauma.
 ;Clinical presentation
;History •
Age;primary hyrocele are most common •
over age of 40 but can occur in children
Secondary are more common between 20 •
.to 40 years
Symptoms;1-painless swelling •
embarrassment-2 –
frequent and painful micturation may occur-3 –
if hydrocele is secondary to epididymo-orchitis
Hydrocele not affect fertility •
 ;Examination
Position; the swelling usually unilateral but can be –
bilateral .if communicating can not feel the cord above
.the lump
Colour and temperature; normal –
Tenderness; primary are not tender but secondary may –
be tender
Composition; fluctuant and have fluid thrill if large –
enough
Reducibility; can not reduced –
Testis impalpable and transillumenate –
PICS OF HYDROCELE
CONT
 ;Mangement
Primary; in children •
Communicating;most neonatal hydrocel –
resolve in first 2 year of life if persists repair
.as herniotomy
Noncommunicating;usually resolves –
spontaneously or needle aspiration may
required