on 25-Sep-2021 (Sat)

A hydrocoele is a swelling that encloses the testis and epi- didymis such that they may be impalpable, and it is possible to get ‘above’ it to palpate a normal spermatic cord (Figure 80.10). They are typically translucent

Be wary of an acute hydrocoele in a young man since there may be a testicular tumour

In congenital hydrocoele, the processus vaginalis is patent and connects with the peritoneal cavity. The communication is usually too small to allow herniation of intra-abdominal contents. Pressure on the hydrocoele does not always empty it but the hydrocoele fluid may drain into the peritoneal cavity when the child is lying down; thus, the hydrocoele may be intermittent. Ascites should be checked for if the swellings are bilateral

An encysted hydrocoele of the cord is a smooth oval swelling that lies above the testis near the spermatic cord, which is liable to be mistaken for an inguinal hernia. The swelling moves downwards and becomes less mobile if the tes- tis is pulled gently downwards. Hydrocoele of the canal of Nuck is a similar condition in females. The cyst lies in relation to the round ligament and is always at least partially within the inguinal canal

Aspiration of the hydrocoele fluid is simple, but the fluid always reaccumulates within a week or so. It may be suitable for men who are unfit for scrotal surgery, although hydrocoele surgery can be undertaken under local anaesthetic. Aspiration can result in bleeding into the hydrocoele sac and haema- tocoele formation. Injection of a sclerosant, such as tetracy- cline, is effective but painful

Filarial hydrocoeles follow repeated attacks of filarial epididymo-orchitis. They vary in size and may develop slowly or very rapidly. Occasionally, the fluid contains liquid fat, which is rich in cholesterol. This is caused by rupture of a lymphatic varix with discharge of chyle into the hydrocoele.

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