Inguinoscrotal Swellings Research Articles

Ventriculoperitoneal shunt and bilateral herniotomies in mucopolysaccharidosis type I: A surgical challenge

ABSTRACT Mucopolysaccharidosis type I or Hurler syndrome (1 in 100,000) is a rare lysosomal storage disorder caused by a defective IDUA gene which codes for α-L-iduronidase enzyme. Enzyme deficiency results in the accumulation of dermatan and heparan sulfate which leads to characteristic facial features, skeletal abnormalities, hepatosplenomegaly, cardiac and pulmonary disease, and progressive mental retardation. A 1-year-old male child presented with chief complaints of increasing head size and bilateral large inguinoscrotal swellings for 5 months. He had a motor developmental delay with poor speech at 1 year of age. The infant weighed 10 kg with a length of 76.5 cm and large head size with head circumference of 53.5 cm (>97 centiles); the anterior fontanel was wide open. Facial features revealed prominent forehead, bilateral corneal clouding, and coarse facies. Per-abdomen examination revealed hepatosplenomegaly; inguinoscrotal evaluation revealed bilateral large reducible indirect inguinal hernias. Radiographic findings suggested dysostosis multiplex. Serial cranial ultrasonography revealed progressive hydrocephalus. Noncontrast computed tomography brain confirmed communicating type of hydrocephalus with periventricular ooze. Considering the clinical history, clinical examination, and skeletal survey, findings were consistent with mucopolysaccharidoses. Urine spot test for glycosaminoglycans for mucopolysaccharidosis was positive. Enzyme analysis of alpha-L-iduronidase showed deficient levels. A molecular study revealed a homozygous mutation in the IDUA gene confirming the diagnosis of Hurler syndrome. The right ventriculoperitoneal shunt was performed after preoperative optimization. Bilateral inguinal hernia repair was contemplated after a gap of 8 weeks. On 9-month follow-up, there was a gradual reduction in ventricular hemispheric ratio, and the patient is doing well on follow-up. Surgical management of the MPS I patient is challenging, but with timely medical and surgical treatment, the prognosis is improving.

A Single-Center Study on Clinico-Radiological Evaluation of Inguino-Scrotal or Labial Swellings Presenting to a Tertiary Care Set-Up in Central India.

Introduction The inguino-scrotal/labial region, anatomically defined as the juncture where the thigh meets the lower abdomen, encompassing the ipsilateral scrotal area in men and the inguino-labial area in women, exhibits a broad spectrum of masses. Traditionally, these swellings were clinically diagnosed with high accuracy, primarily due to the prevalence of simple hernias and hydroceles. However, contemporary observations reveal a surge in complex inguino-scrotal/labial swellings, particularly in referral hospitals, necessitating additional radiological and imaging modalities for precise diagnosis. Our interest in this subject was sparked by the escalating numbers of intricate inguino-scrotal/labial masses encountered in our medical setting, posing challenges for clinical diagnosis in both pediatric and adult populations. Materials and methods A prospective, observational study was conducted over two years (August 2021 to March 2023) involving 210 patients presenting with inguino-scrotal/labial swellings at our institute. Clinical data were meticulously collected using a designed pro forma, following informed consent procedures. Results Among the 210 patients with inguino-scrotal/labial swellings, males predominated (194) compared to females (16). The paediatric age group comprised 84 patients, while 126 were adults. Radiological investigations played a crucial role in diagnosing 40 patients and provided significant additional information in 12 cases. Radiological investigations contributed to the diagnosis in 52 patients (24.76%). The study revealed a spectrum of new entities in the inguino-scrotal/labial region, including malignancies, lymph nodal masses in the groin, and vascular, inflammatory, and congenital lesions, which might have been overlooked if solely relying on clinical parameters for diagnosis. Conclusion Inguino-scrotal/labial swelling patients, especially those facing diagnostic dilemmas or harbouring complex lesions, should undergo radiological assessment as an indispensable criterion, particularly when such facilities are readily accessible.

A study of clinical analysis and management of lnguinoscrotal swelling in paediatric age group

Background: Inguinoscrotal swellings are one of the commonest congenital problems in infancy and childhood. Delay in diagnosis and treatment leads to loss of testis, ovaries or portion of bowel to incarceration or strangulation. This study was undertaken for clinical evaluation of age, sex, sidewise distribution management and management of complications.Methods: Retrospective observational study done from April 2011 to March 2019. Children with age from 1 month to 12 years presenting with inguinoscrotal swelling Results: In Total 174 children had inguinoscrotal swelling which include 155 (89%) male children and 19 (11%) female children. Most of the patients presented in 2 to 5 years (41%) age group out of 114 case of inguinal hernia include 63 on right,47 on left and 4 bilateral and 60 case of hydrocele 48 on right,10 on left and 2 bilateral.0ut of 174 children 16 were discharge on same day of surgery. Out of 174 children 1 patient had taken as emergency operation due to irreducible hernia. Conclusions: Inguinal hernia and hydrocele in children remain one of the most common congenital problems observed by surgeons. The childhood inguinoscrotal swellings are generally more predominant on the right side and this has been attributed to the delay in descent of the right testis. Regarding the sex prevalence, males are more commonly affected. Inguinal herniotomy in children is a safe and effective operation done as day care procedure.

Nuck cyst: a rare cause of inguinal swelling in infancy.

BACKGROUND Inguinal and/or inguino-scrotal swellings, such as hernia and hydrocele, are among the commonest anomalies in childhood. Hydrocele of the canal of Nuck is an uncommon diagnosis and a rare cause of swelling in women that occurs due to a patent vaginal process. METHODS From January 2001 to January 2016, 353 female patients 1-14 years of age were admitted to our university hospital division for inguinal swelling. We have performed 403 inguinal approaches, and of these, 399 (99%) had inguinal hernias, 3 (0.74%) had a cyst of the canal of Nuck, and 1 (0.24%) had a lipoma. All of the patients with Nuck cysts underwent surgical exploration of the swelling through a right inguinal skin crease incision. RESULTS The patients were between the ages of 1 and 8 years. The cyst sizes varied between 25 and 40 mm. All the patients exhibited right, tender, painless, non-reducible masses. In all patients, ultrasound confirmed the suspected diagnosis. The histological findings revealed fibrous-walled cystic formations with mild chronic inflammatory infiltrate that were covered by mesothelial epithelium. The patients' postoperative follow-ups at 1, 6 and 12 months revealed normally healed incisions with no recurrences. CONCLUSIONS The surgical findings and the histological demonstrations of serous epithelium seemed to validate the hypothesis that the patency of the inguinal canal combined with fluid secretion of the peritoneal serosa participated in the formation of the cysts. Surgery with high ligature of the vaginal process is considered the therapy of choice for this pathology.

Malignant mesothelioma of the spermatic cord mimicking a benign inguinoscrotal swelling: case report with review of literature

BackgroundSpermatic cord malignant mesotheliomas (SCM) are extremely rare tumours arising from the tunica vaginalis of the spermatic cord (only 18 cases reported—worldwide in the literature). Paratesticular malignant mesotheliomas (PMM) account for about 0.3–1.4% of all mesotheliomas, while those from the spermatic cord account for less than 10% of paratesticular tumours. Spermatic cord mesotheliomas may be overlooked commonly owing to its unique ability to mimic benign disorders associated with a thickened cord, leading to loss of timely management in many cases. Hence, this case report hence serves to provide pointers to the urologist/surgeon and alerts them towards timely diagnosis and early management of SCM’s besides adding to its limited literature.Case presentationWe present a case of spermatic cord mesothelioma (SCM) in a 39-year-old male presenting to our clinic with persistentcomplaints of left inguinoscrotal swelling with a vague dull-aching, poorly localising pain sensation over the inguinoscrotal region associated with a persistent dragging sensation for more than a year. Initial evaluation suggested and inclined us towards the diagnosis a benign pathology (spermatocele); however, the persistence of symptoms (pain and swelling) despite prior therapeutic measures initiated elsewhere prompted us to consider an FNAC (which was benign) and surgical exploration which surprisingly revealed the diagnosis of SCM. Owing to the wide spread nature of the disease, the patient was started on palliative chemotherapy. He is currently is doing clinically well on a 1-year follow-up.ConclusionSpermatic cord malignant mesothelioma is an extremely rare tumour with an unique tendency to masquerade and mimic cord thickening also associated with several other benign groin/inguinoscrotal swellings. In all such cases, a high index of suspicion should be entertained by the urologist, even in the absence of classical risk factors for SCM like prior asbestos exposure while evaluating patients presenting with persistent expanding inguinoscrotal swellings associated with non-resolving symptoms.

ULTRASOUND EVALUATION OF INGUINOSCROTALAND INGUINOLABIAL SWELLING IN INFANTS.

Objectives: Inguinoscrotal and inguinolabial swellings are common findings in children. In this study, doppler ultrasound was used to identify the various causes of inguinoscrotal and inguinolabial swelling, thus helping to decide on the timely and optimal management. Patients and methods: 50infants with a history of swelling in the inguinoscrotal or inguinolabial region were included in the study. All infants were subjected to ultrasound with doppler study. Results: Out of 45 male infants with inguinoscrotal swelling 40were found to have chronic, 5acute and Out of 5 female infants, 4 were found to have chronic and acute inguinolabial swelling. Conclusion: ultrasound with color doppler study is an accurate, first line and effective diagnostic tool which can be used to identify the cause of inguinoscrotal and inguinolabial swelling in infants.

Scrotal hitch: a novel technique to reduce post-operative scrotal oedema in inguinal hernia surgeries: a pilot study

Background: Inguinoscrotal swellings are the most common presenting complaints in the surgical out patient department and surgeries for the same are the most commonly done elective procedures.However meticulous the surgeon is, there is always some amount of scrotal oedema. Our study is intended to use a simple and novel technique by applying a scrotal hitch after the surgery to prevent the scrotal oedema. The aim of the study was to evaluate the effectiveness of a scrotal hitch in reducing the scrotal oedema and pain postoperatively.Methods: In this study all subjects undergoing inguinal hernia surgeries at undergoing at R.L. Jalappa Hospital, Kolar from June 2019 to August 2019 were included. Of the 60 subjects, 30 in group A were given scrotal hitch and subjects in group B were given scrotal support alone. The incidence of scrotal oedema and postoperative pain and development of any complications will be compared in both the groups.Results: A total of 60 subjects were included in this study. Mean age of patients in group A is 45.63±21.745 and group B is 41.43±24.579. 2 patients with scrotal hitch developed scrotal edema whereas 6 patients developed scrotal edema in group B. The post-operative pain score was lower in patients with scrotal hitch.Conclusions: Scrotal hitch is a simple and effective technique in preventing post-operative oedema and pain. The results of this study would encourage surgeons to take up this simple procedure to prevent the commonest complication of inguino-scrotal surgeries.

Nuck cyst: a rare cause of inguinal swelling in infancy.

Inguinal and/or inguino-scrotal swellings, such as hernia and hydrocele, are among the commonest anomalies in childhood. Hydrocele of the canal of Nuck is an uncommon diagnosis and a rare cause of swelling in women that occurs due to a patent vaginal process. From January 2001 to January 2016, 353 female patients 1-14 years of age were admitted to our university hospital division for inguinal swelling. We have performed 403 inguinal approaches, and of these, 399 (99%) had inguinal hernias, 3 (0.74%) had a cyst of the canal of Nuck, and 1 (0.24%) had a lipoma. All of the patients with Nuck cysts underwent surgical exploration of the swelling through a right inguinal skin crease incision. The patients were between the ages of 1 and 8 years. The cyst sizes varied between 25 and 40 mm. All the patients exhibited right, tender, painless, non-reducible masses. In all patients, ultrasound confirmed the suspected diagnosis. The histological findings revealed fibrous-walled cystic formations with mild chronic inflammatory infiltrate that were covered by mesothelial epithelium. The patients' postoperative follow-ups at 1, 6 and 12 months revealed normally healed incisions with no recurrences. The surgical findings and the histological demonstrations of serous epithelium seemed to validate the hypothesis that the patency of the inguinal canal combined with fluid secretion of the peritoneal serosa participated in the formation of the cysts. Surgery with high ligature of the vaginal process is considered the therapy of choice for this pathology.

A study of inguinal hernia in children

Background: Inguinoscrotal swellings are one of the commonest anomalies in infancy and childhood throughout the world. Delay in diagnosis and treatment leads to loss of testis, ovaries or portion of bowel to incarceration or strangulation. This study was undertaken to evaluate the age, sex and sidewise distribution and the complications like incarceration, strangulation and gonadal infarction.Methods: A total of 50 children were selected ranging in age from new born to 12 years presenting with inguinoscrotal swelling which were examined, followed up and managed.Results: The inguinal hernia was most common among male children (92%) thereby giving a ratio of M: F=11.5:1. The children were aged new born -12 years and most of the patients presented around 2 to 7(46%) years and prematurity noticed in 10% of cases. Right sided (64%) inguinal hernia was more common than left (28%). In this study indirect hernia is 98% and direct is 2%. In 16 cases of hydrocele, 10 were on the left side and 6 were on the right and 6 cases were encysted hydrocele. High ligation at the level of deep ring was done in all the cases. In this series of 50 children, there were 2 cases of incarceration. But none had strangulation and gonadal infarction.Conclusions: Inguinal hernia is a common surgical condition in children. Elective surgery is associated with minimal complications. Incarceration is more common in infancy with chances of recurrence if explored in emergency.

A study of clinical evaluation and management of inguinoscrotal swelling in paediatric age group

Background: Inguino-scrotal swellings are one of the commonest problems in infancy and childhood throughout the world. They represent the conditions most frequently requiring surgical repair in the paediatric age group. In many of these cases, clinical examination may suffice to obtain a definite diagnosis, but when the diagnosis is inconclusive, ultrasonography can play an important role. Post-operative complications are usually rare following elective operation whereas minor complications do occur after emergency operation. In this study we evaluated various presentations of inguino-scrotal swellings, their management and complications in paediatric age group.Methods: This is a hospital based prospective study, to have an overview of a spectrum of the paediatric cases admitted in the department of surgery with inguino-scrotal swelling that includes 40 patients with age below 13 years, irrespective of sex. Data regarding clinical features, birth history, immunization, family history various blood and radiological investigations was noted. Incidences of associated anomalies, complications and any form of treatment given to the patient were recorded and findings were analysed.Results: Out of 40 cases, all were males with maximum number of cases between the age group of 3-4 years.24 cases were right sided, 12 left sided and 4 bilateral. Hydrocele was associated with 10 of the cases, undescended testis with 2 cases and 1 had encysted hydrocele of the cord. There were no complicated cases like incarceration, obstruction or strangulation. Post-operative complications were noted in 4 cases, out of which 2 were wound haematoma and one case each of wound infection and stitch granuloma.Conclusions: Childhood inguinal hernias are more common on right side due to delay in descent of right testis and males are more commonly affected. Congenital hydrocele may involutes spontaneously, so we should observed at least upto 1 year of age before considering repair but not in the case of congenital inguinal hernia. Inguinal herniotomy in children is a safe and effective operation.

A Clinical Study and Management of Inguino-scrotal Swellings In Children

Aims and Objectives: To know the most common surgical problems in pediatric patients presented with inguino-scrotal swellings and management done routinely.
 Methodology: This study was carried out in the department of general surgery, Sharadaben hospital and pediatric surgery of VS hospital, Ahmedabad. The cases were studied for a period of about one year (January, 2017 to Dec, 2017) and all children below 12 years of age, presenting to us with inguinoscrotal swellings were included in this study. The information was analysed in terms of age, diagnosis, procedure carried out and outcome.
 Results: Amongst the 150 children under the age of 12 years, 143 patients were males and 7 were females. Among these 150, 52 cases were of hydrocoele, 70 cases of hernia (of which 63 were males and 7 were females), 25 cases of undescended testis and 3 cases of epididymo orchitis were documented. All cases underwent simple herniotomy for hernia and hydrocoele, orchidopexy for undescended testis. The length of hospital stay ranged from 2-4 days with mean of 2.46 days. 11 children in the study were documented to have short term complications, all of which were recognised in the hospital and managed with good results.
 Conclusion: Hernia and Hydrocoele in children are often congenital and diagnosed clinically (history and examination). Indirect inguinal hernia are more common than other groin hernias. Open herniotomy is the operation of choice for inguinal hernia in children.

Role of Cytology in Detection of Unsuspected Carriers of Microfilariae: A Retrospective Study in National Capital Region (NCR), India

Background: Filariasis, a global problem, is a major public health issue in India. Despite its high incidence, it is unusual to detect microfilaria in cytological smears, though unexpected detection of microfilariae in fine needle aspiration cytology (FNAC), exfoliative and fluid cytology have been reported previously. The study analyzed the role of cytology in detection of asymptomatic carriers of microfilariae.Methods: This was a retrospective, observational study and included cases of filariasis from cytological records spanning five years. The epidemiological, clinical, hematologic and radiologic details were noted. The slides were retrieved and examined. Descriptive statistical analysis was utilized.Result: Filariasis was diagnosed in 0.03% of the total cytology cases studied during the period, constituting 0.04% of FNACs (two cases of inguino-scrotal swellings, two of breast lumps, one of thyroid swelling) and 0.02% of cervicovaginal smears (two cases). None of them was clinically suspected to be filariasis. Radiological examination was also misleading. None of the cases demonstrated raised leukocytosis or microfilaremia and eosinophilia was present in 3 cases (42.9%). Apart from microfilariae of Wuchereria bancrofti, eggs were present in one case. This was associated with inflammation in all cases, cell adherence in 42.9% and coexistent hyperplastic and neoplastic conditions in 57.1% cases.Conclusion: The detection of microfilariae in cytological material in the absence of clinical, radiologic or hematologic suspicion, in an area of relatively low prevalence of filaria, points to the need for a high index of suspicion and careful screening of all smears, as cytology may play an important role in the diagnosis of asymptomatic carriers of microfilariae.DOI:10.21276/APALM.1727

A Prospective Study on Prevalence and Management of Inguinal Hernia in Infants and Children

Introduction: Inguino-scrotal swellings are frequently observed in patients of pediatric age group. Inguinal hernia and Hydrocele are the most common causes of such swellings in children. For their effective management, it is essential to study various factors like age, sex etc. associated with inguinal hernia in pediatric age group. Objectives: To study the epidemiology, management and outcome of inguinal hernia in children. Methods: A prospective study was conducted on pediatric patients with inguinal hernia for a period of 18 months. Patients from newborn to 14 years of age were selected for this study on the basis of inclusion and exclusion criteria. Result: Inguinal hernia can occur at any age, but the majority of patients are seen between 1 to 5 years of age. It is more commonly seen in male children and incidence is slightly higher on right side. Almost all of the inguinal hernia in pediatric age group is of indirect type, which develops due to congenitally patent processus vaginalis. Conclusion: Early surgical intervention in form of Inguinal herniotomy is the most appropriate management of inguinal hernia in children.