SURGERY CASE

PRESENTATION

Mentor:
Thirumagal T
Dr. Srinivasan
Professor of Surgery Final Year MBBS
Coimbatore Medical College Coimbatore Medical College
Details of the • A 37 year old male from Peelamedu, Coimbatore

patient who is a construction worker by occupation was

examined on 22/10/21
 Chief • Swelling in the left side of the scrotum for the past

complaints 10 months
History of • The patient was apparently normal before 10 months, then he

presenting noticed a swelling on the left side of scrotum

illness • It was insidious in onset and has gradually progressed to the

present size

• The swelling doesn't reduce in size on lying down or increase on

coughing
• No h/o pain

• No h/o trauma

• No h/o fever with chills and rigor

• No h/o sudden increase in size of the swelling

• No h/o loss of weight

• No h/o any other swelling

Past history • No h/o similar swellings in the past

• No h/o previous surgeries and hospitalization

• Not a known case of diabetes, hypertension,

tuberculosis, filariasis, asthma, epilepsy

Personal • Consumes mixed diet

history
• Normal bowel and bladder movements

• Not a smoker

• Not an alcoholic
Family History • No significant family history
Summary A 37 year old gentleman came to CMCH with a left

sided painless scrotal swelling, insidious in onset

and gradually progressive for the past 10 months

and not associated with trauma and fever.

 General After getting an informed consent from the patient, the following

Examination examinations were done

• Patient is conscious , oriented , moderately built and well nourished

• Afebrile

• No pallor , not icteric

• No cyanosis, no clubbing

• No pedal edema

• No generalized lymphadenopathy
VITALS

• Pulse- 74 beats/min regular, with normal character and volume

• RR- 16 breaths/min , abdominothoracic

• BP- 110/80 mmHg , measured in left upper limb in sitting posture

• Temperature- 36.8°C
 • After explaining the procedure to the patient and

Local
getting consent, the patient was adequately
Examination
exposed from nipples to the knees and the local

examination was done with patient in standing

position in the presence of a male attender

INSPECTION

• Left sided scrotal swelling , globular in shape,

extending from root of penis to base of scrotum

• Skin over the scrotum appears stretched with

mild loss of rugosity

• No redness over the swelling

• No scars , sinuses

• Penis is in midline

• No increase in size on coughing

• Size doesn’t reduce on lying down

• Abdomen and inguinal region appears normal

• Right side is normal

PALPATION

• Inspection findings were confirmed

• No local rise of temperature

• No tenderness

• Swelling measures about 8x6 cms

• Able to get above the swelling at the root of scrotum and feel the cord structures

• Swelling is cystic in consistency

• Fluctuation test – Positive

• Transillumination test – Positive

• Left testis is not palpable separately from the swelling

• Cough impulse - absent

• Swelling is not reducible

• Normal left cord structures

• Right side of the scrotum is normal

Lymph node • No palpable inguinal lymph nodes

examination

• Abdomen: Soft, non tender, no palpable organomegaly

Systemic
examination • RS: Normal vesicular breath sounds heard, no added

sounds

• CVS: S1, S2 heard, no murmurs

• CNS: No focal neurological deficits

 Provisional Diagnosis
A 37 year old gentleman presented with

• A left sided globular swelling which was insidious in onset, gradually progressive for the past 10

months and is currently measuring 8x6 cms. It is a painless, non- reducible scrotal swelling which

is not associated with trauma and fever.

• On examination ,was able to get over the swelling and feel normal cord structures. The swelling

was cystic in consistency, fluctuant, trans illuminant and testis was not palpable separately

• This is probably a case of left sided Primary Vaginal Hydrocoele