KAMPALA INTERNATIONAL

WESTERN CAMPUS

NAME: JOY MBAIRE KARUE

REGISTRATION NO: BMS/7029/62/DF

FACULTY: HEALTH SCIENCE- CLINICALS

DEPARTMENT: SURGERY

WRITE UP: CASE REPORT ON HYDROCELE

DATE: 10/8 /2010

SURGEONS: DR. WACHAYA

DR. SHABAAN
DR. MUTORO
DR. KIZZA
DR. JO KWANG
REPORT ON THE CLERKSHIP OF PAUL TAREMWA

NAME : Paul Taremwa

AGE : 4 1/2 Years

SEX : Male

ADDRESS : Kashozi

TRIBE : Munyakole

OCCUPATION OF PARENT: Pastor

RELIGION : Protestant

INFORMANT : Father (Dan Karashani)

EDUCATION LEVEL: Pre- school

NEXT OF KIN : Father

NEAREST HEALTH CENTER: Kashozi Health Centre

DATE OF CLERKSHIP: 5/8/2010

DATE OF ADMISSION: 5/8/2010

PRESENTING COMPLAINT

Swollen scrotum for one day

HISTORY OF PRESENTING COMPLAINTS

Patient was well till one day prior to admission, when a swelling in the scrotum appeared which was
gradual on onset. It isn’t aggravated by anything or associated with any factors. The swelling hasn’t
increased in size nor has it changed its appearance. There’s no reported problems with urination like
pain, slow stream, blood stained urine or the feel to always urinate. No loss of weight, or history of
trauma. This is the first case of scrotal swelling, in the patient.

REVIEW OF OTHER SYSTEMS

CARDIOVASCULAR SYSTEM
He has never had any history of difficulty in breathing, dizziness, orthopnea or leg swellings.

RESPIRATORY SYSTEM
He has an associated chest pain, no cough or dyspnoea.

MUSCULOSKELETAL SYSTEM
No joint pains, swellings or muscle aches

CENTRAL NERVOUS SYSTEM

No history of fever, headaches, loss of consciousness or visual disturbances (blurred vision), or ear
problems.

GASTROINTESTINAL SYSTEM
No nausea, vomiting, diarrhoea or constipation.

PAST MEDICAL HISTORY

This is he’s index admission.
The patient had a history of splenomegally, but was given medication and got better.
He has no known allergies.

PAST SURGICAL HISTORY

He has never had any surgical procedures or blood transfusions done.

FAMILY HISTORY
The patient’s the 3rd born in a family of 4 children. Both parents are alive and well.
The grandfather has diabetes, but there’s no other history of any chronic illnesses like hypertension,
asthma or epilepsy.

SOCIAL HISTORY
The family lives in a semi-permanent house with two rooms, all their windows have ventilation.
The family sleep under mosquito treated nets.
Their source of water is a well, and boil their water for drinking.
They throw their rubbish in a pit latrine that’s behind their house.

SUMMARY
Paul Taremwa is a 4 ½ year old, who presented with a scrotal swelling for one day. The onset was
gradual and had no associated pain. There was also no dysuria, urge or frequency to micturate.

EXAM.

GENERAL EXAM
The patient was lying in supine position, was conscious and was well nutritioned.
He had no jaundice, palour, finger clubbing, cyanosis, oedema, enlarged lymph nodes or dehydration.
He’s vitals were as follows: BP = 90/68mmHg
Temperature = 35.9celcius
Pulse Rate = 98Breaths per minute
Respiratory Rate = 21Breaths per minute

LOCAL EXAM

GENITOURINARY EXAM
Inspection
The was no hair present, discharge or swellings.
The swelling was unilateral, pinkish in colour and had a smooth surface.
No change detected when I asked the patient to cough, no protruding veins, no scars or wounds
seen.
Palpation
The temperature was the same as the rest of the body.
Consistency was soft, swelling was tense, and there was translucency, when I put a pen torch on one
side of the swelling, I could also go above the swelling.
There was no tenderness, skin wasn’t fixed to the underlying skin, and the swelling couldn’t be
reduced or compressed.
The regional lymph nodes weren’t enlarged.
Percussion
Couldn’t be detected.

Auscultation
Couldn’t be detected.

SYSTEMIC EXAM

CARDIOVASCULAR SYSTEM EXAM

The Pulse rate was 98bpm, regular, was of adequate volume and synchronous with femoral pulse.
The Blood pressure was 90/68mmHg and the JVP wasn’t elevated..
The Apex beat was present and located at the 5th intercostal space along the midclavicular line.
On Auscultation, the heart sounds S1 and S2 were heard on added heart sounds or murmurs.

RESPIRATORY SYSTEM EXAM

The Respiratory rate was 21bpm.
The chest was symmetrical with no deformities or scars.
Trachea was centrally placed.
There was no tenderness and the chest expansion was symmetrical and normal on both sides.
The chest was of normal resonance both anteriorly and posteriorly.
There were no crepitations and there was good air entry in both lungs.

CENTRAL NERVOUS SYSTEM EXAM

The patient was fully conscious and awake.
He’s pupils were both round, symmetrical and were responsive to light.
He’s hearing and eyesight was quite good and claimed not to have any disturbances.

MUSCULOSKELATAL SYSTEM EXAM

The patient had normal gait, had upright posture, good movement, and had no deformities, neither
walking aid nor muscle wasting.
The patient had no tenderness or stiffness in he’s muscles, joints or back. No swellings around he’s
joints.

IMPRESSION
Hydrocele with evidence of a tense scrotal swelling, which had translucent consistency and I couldn’t
get above the swelling.
DIFFERENTIAL DIAGNOSIS
Inguinal hernia, varicocele, late or missed torsion of spermatic cord, spermatocele of epidydymis

PLAN
Admit patient and monitor.

FOLLOW UP

5/8/2010
Patient was admitted and clerked.
Patient’s vitals which were taken were as follows:
BP=90/68mmHg
TEMP=35.9celcius
Pulse Rate=98beats per minute
Respiratory Rate=21breaths per minute
6/8/2010
Patient was presented to a surgeon, discussed and a congenital herniatomy was to be done the
following day.
Patient was advised not eat or drink anything following the day of surgery.

7/8/2010
Patient was prepared for surgery, and the respective items for surgery were bought.
The procedure was successfully done, and the patient was taken to the post operative wing.
He’s vitals were taken, and were as follows:
BP=86/62mmHg
TEMP=36.0celcius
Pulse Rate=94beats per minute
Respiratory Rate=23breaths per minute
The patient was given antibiotics and analgesics.

8/8/2010
Patient was well, conscious and lying in bed in the supine position.
The patient was eating food and taking fluids orally.
He was passing urine well.

9/8/2010
The patient was ambulating.
The patient was still eating and drinking, without any problems.

10/8/2010
Patient was discharged on antibiotics and analgesics, and told to come for review a month later.

DISCUSSION
A hydrocele is an abnormal accumulation of serous fluid in some part of the processus vaginalis,
usually the tunica. The serous fluid can be amber, sterile, may contain albumin or fibrinogen. When
the hydrocele was incised, clear fluid was drained.
The two types of hydrocele are: congenital and acquired.
Basing on the age of the patient, this might be congenital [Link] four types of congenital
hydrocele are vaginal, infantile, encysted and congenital. Vagina hydrocele is painless, and one can
palpate the testis, if the hydrocele is lax, infantile hydrocele occurs when the processus vaginalis are
descended into the inguinal ring, but there’s no connection with the peritoneal cavity. Congenital
hydrocele is when the processus vaginalis is patent, hence connects to the peritoneal cavity,
especially when the child lies down. Encysted hydrocele is a smooth oval swelling near the spermatic
cord, which is mostly mistaken for an inguinal hernia, this swelling goes downwards and is less mobile
and this happens when the testes is moved downwards.
The three types of acquired hydrocele are primary, idiopathic and secondary to testicular disease.
Hydroceles are known to be caused by four ways: excessive production of fluid within the sac,
defective absorption of fluid, interference with the lymphatic drainage of scrotal structures and
connection with a hernia of the peritoneal cavity.
My patient presented with a scrotal swelling which was translucent, and I could get above the
swelling. This excluded the chance of the swelling being a hernia. The fact that it was translucent,
meant it had fluid, hence the transmission of light. This excluded other scrotal swellings, like cysts of
the spermatocele, varicocele (which feels like a bag of worms), or late or missed torsion of spermatic
cord.
Other modes of treatment besides congenital herniatomy, are Lord’s operation, done when the sac is
thin walled and Jaboulay’s procedure whereby tapping is done by draining the fluid through a
cannula, but this procedure is done in old men.
The complications are rupture of the swelling, transformation into haematocele or the swelling may
calcify. This makes it necessary for a surgical procedure to be done, as soon as possible.
REFERENCES
SAYID AL-YAHUD
Physical exam and differential diagnosis in surgery

BAILEY AND LOVE’S

SABISTON TEXTBOOK OF SURGERY

17TH EDITION

OXFORD HANDBOOK OF CLINICAL SURGERY