Inguinal Scrotal Swellings
Inguinal Scrotal Swellings
Inguinal Scrotal Swellings
SWELLINGS
Definition
- Embryonic
developmental
outpouching of the
peritoneum.
- In males, it precedes the
testes in their descent
down within the
gubernaculum and closes.
- The remaining portion
around the testes becomes
the tunica vaginalis
• Failure of closure of processus vaginalis :
Other causes :
1. Saphena varix
2. Femoral artery aneurysm
3. Groin abscess
4. Lipoma of the cord
5. Varicocele (‘bag of worms’ consistency)
6. Undescended testes (cryptorchidism)
7. Ectopic testis
8. Hydrocele of cord or the canal of Nuck
9. Hematocele
10. Testicular cancer
11. Testicular torsion
12. Epididymo-orchitis
History taking
When the lump 1st noticed?
What made the patient notice the lump? (pain/when
washing/someone else noticed)
What are the symptoms related to the lump?
Has the lump changed since it was first noticed?
(size/change in nature)
Does the lump ever disappear? What makes the lump
disappear? (on lying down/while exercise)
Has the patient had any other lumps?
What does the patient think caused the lump ?
Is there any discharge?
What has been suggested and administered?
• Ask about potential complications of hernia :
1. Irreducibility
2. Obstruction : abdominal pain, distension, constipation, vomiting
3. Strangulation : tender, painful, skin changes over the swelling
Allergic :
-Egg (burung puyuh) and mussels nausea and vomiting
- Ponstan medication swollen lips
- Sardine gout (has to take painkiller and anti-gout)
Family history :
-He is the 2nd out of 5 siblings. Two of his younger siblings passed
away due to heart failure.
- He has a strong family history of diabetes mellitus, hypertension,
hypercholesterolemia and cardiac disease.
- His mom had diabetes mellitus, hypertension and cardiac disease
(passed away due to heart failure)
- His dad has hypertension and gout.
- There is no family member having the same symptom as him.
- No malignancy running in the family.
- He has 3 children. All are healthy.
- His wife has hypertension.
Social history :
- He had stopped smoking since 15 years ago. He is a non alcoholic and
does not take drugs for pleasure.
-He had retired for 3 years (police rescue team)
- He lives in Kg Melayu, Subang with his family.
Summary :
In summary, ZBJ, a 59 year-old Malay man, day 1 post elective
hernioplasty was admitted with chief complaint of left inguinal swelling 5
months prior to admission. The swelling was reducible, painless with no
skin changes over it but it got bigger since last 2 months. It was not
associated with other symptoms. He was a body builder with routine weight
lifting and worked in police rescue team. He was also obese with BMI of
34. Otherwise no history of chronic coughing, no constipation and no
straining during micturition.
Examination
a) Inspection :
i. Single/multiple
ii. Site/position
iii. Size
iv. Shape
v. Colour and texture overlying
vi. Surface
vii. Pulsation
viii. Expansile cough impulse (in hernia, swelling becomes larger and more tense in all directions
when coughing)
b) Palpation :
i. Confirm the inspection explanation
ii. Mobility
iii. Margin
iv. Consistency
v. Fluctuation
vi. Temperature of the skin overlying the hernia
vii. Transillumination
viii. Occlusion test
ix. Reducibility
- In males, palpate the testis and spermatic cord (decide whether the lump is a hernia or
a true scrotal lump)
1. If can get above it (feel its upper edge with normal spermatic cord) = true scrotal
swelling
2. If the lump has no upper edge because it passes into the inguinal canal = hernia
d) Auscultation :
- Bowel sound may be heard in hernia containing gut
- Peristalsis in enterocele
Midpoint of inguinal canal vs mid-
inguinal point
Midpoint of inguinal canal Mid-inguinal point
Midpoint between ASIS and pubic Midpoint between ASIS and pubic
tubercle symphysis
a) Skin
b) Superficial fascia (fascia Camper and
Scarpa’s fascia)
c) Muscles :
i. External oblique ms
ii. Internal oblique ms
iii. Transversus abdominis
d) Transversalis fascia
e) Extraperitoneal fat
f) Peritoneum
g) Organs