Groin Swelling

  • it can be inguino-scrotal swelling

Common diagnosis

  1. Hernia

  2. Testicular tumour

  3. Hydrocele

  4. Varicocele - can only be seen when standing

Examination

  1. Groin examination

  2. Abdominal examination- to check intra-abdominal mass

  3. Per rectal examination- to check BPH

  4. Special test (done the test when pt standing up)

    • Occlusion test

    • Transillumination test (have to done in dark room)

*don't reduce the hernia when pt is standing


Hernia

  • Direct hernia - hernia directly goes out through ant. abd. wall

  • Indirect hernia - hernia goes out through deep inguinal ring

Hernia Hydrocele
- bulging from inguinal to scrotum - only the scrotum bulges out
- can still feel the normal size of testis - cannot feel the normal size of testis

Complications:

  • Incarcerated/irreducible

  • Strangulation

  • Obstruction

  • Ischemia - (bowel ischemia) when there is present of haemorrhagic fluid

  • Gangrene

Investigations:

  • Do investigations to elicit the cause of increased intra-abdominal pressure.

  • Hernia repair is useless if the cause is not settled down.

  • Causes of increased intra-abdominal pressure:

    • Intra-abdominal mass

    • Straining

    • BPH

Management:

  • Hernioplasty - done by using prolene mesh

  • Herniorrhaphy - done by using prolene suture

  • Herniotomy - usually done in children because their deep inguinal ring still not fully developed yet