Name: Mucinguzi Brian
Age: 6 years old
Sex: Male
Address:, Bushenyi district
Religion: Catholic (parents)
Tribe: Wanyankole (parents)
Informant: Mumeosabe verentwa (the mother)
Education level: N/A
Occupation: Peasant (Parents)
Next Of Kin: Rwanyurukus Donozio (the father)
Date of Admission: 30TH AUGUST 2010
Date of discharge: 6TH SEPTEMBER 2010
Inpatient no:
PRESENTING COMPLAINT
Left sided scrotal swelling on and off for 1 year.
HISTORY OF PRESENTING COMPLAINT
The child has been fairly unwell for the past one when the parents noted left scrotal swelling which was
of gradual onset, at first appears on and off but later could persist for few days and then regress. The
swelling appeared spontaneously and disappears on its own. There was no association of fever, pain or
positional changes.
It’s a moderate swelling which did not interfered with child’s playing. The mother reported no history of
chronic cough or any other chronic illness prior to the onset. There was no history of dysuria, increased
micturation frequency or urethral discharge.
REVIEW OF OTHER SYSTEMS
Respiratory system: No cough, chest pain, difficulty in breathing, haemoptysis or wheeze.
Cardiovascular system: No history of palpitation, easy fatigability, orthpnoea, paroxysmal nocturnal
dyspnoea or body swelling.
Gastrointestinal system: No history of abdominal pain, vomiting, diarrhea, constipation, dysphagia,
odenophagia or dyspepsia.
Musculoskeletal system: There is history of backache and joints pain but no bones pains, swelling or
inability to use any limbs.
Central nervous system: There was no history of headache, dizziness, tinnitus, convulsions or loss of
consciousness.
PAST SURGICAL HISTORY
Has never been undergone any operation, any history of blood transfusion or sustain any trauma or
burns.
PAST MEDICAL HISTORY
This was his 2rd admission, the first was due to malaria treated and recovered. Has no drug or food
allergy known to him and he reports no other chronic illness known to him though his HIV sero-status
was unknown.
PREGNANCY AND BIRTH HISTORY
Prenatal: - The mother attended anti-natal clinic three times and received fansider 3 doses with other
haematenic supplements.
Natal history:-The baby was delivered in a health centre through spontaneous vertex delivery; he cried
immediately and weighed 3kgs. The baby did not have any other problem.
Immunization history: The mother reported that the baby was fully immunized and was evidenced with
right deltoid scar for BCG.
Nutritional history: He is currently feeding on normal diet.
Developmental milestones -were attained normally and currently the child is walking, running and
talking normally.
FAMILY SOCIAL HISTORY
Both parents are alive and well. He is the 6th born in a family of 7 siblings who are all alive and well.
There is no history of hypertension, diabetes mellitus, asthma or epilepsy in the family.
Both parents are peasants staying in a semi-permanent house and obtain water from the well and boil
for drinking.
SUMMARY
Mucinguzi a 6 year old boy who presented with a history of left sided scrotal swelling on and off for one
year. It was of spontaneous onset and not associated with fever, pain, dysuria or urethral discharge.
GENERAL EXAMINATION
A young boy of good general condition, not in distress, fully conscious and alert. He was clinically a
febrile with temperature of 36.40c and mild pallor. He had scattered scratch marks and round skin
eruptions on the right dorsal foot. There was no jaundice, cyanosis, edema, palpable lymphadonepathy,
dehydration or mouth ulcers/ thrush.
LOCAL EXAMINATION
The left scrotum was mildly enlarged but of normal color and no discharge. Could go above the swelling
and it was soft, fluctuant and non tender. The right side appeared of normal size and both testes were
palpable, not enlarged or tender. Tran-illumination test was positive and there was no cough impulse.
Needle aspiration done and obtain 4mls of amber fluid.
SYSTEMIC EXAMINATIONS
PER ABDOMEN
Symmetrical abdominal distension which moves with respiration, no obvious swellings, scars, collaterals
or visible peristaltic movements. No tenderness elicited on deep palpation, and the liver, spleen and
kidneys were impalpable. All hernias orifices were patent and there was normal tympanic note with
normal pitched bowel sounds.
Digital rectal examination was not done.
Cardiovascular System
Pulse rate – 65beats per minute, normal volume, regular and synchronous with ipslaterall femoral pulse.
The Blood Pressure was not done.
No hyperactivity of precordium and apex beat is in the 5th intercostals space mid clavicular line. There
were no thrills or heaves. Heart sounds 1 and 2 heard and regular with no added sounds or murmurs.
Respiratory system
Respiratory rate – 20 cycles per minute.
Normal chest with no scars or therapeutic marks. The trachea was centrally placed and the 5 th
intercostals space mid clavicular line. The chest movement, expansion and vocal fremitus were equal
and normal. It was of normal chest resonant with vascular breath sounds and no crackles or wheeze
with equal and normal vocal resonant.
Central Nervous System
An elderly lady who was fully conscious, alert, well oriented to time, place and person. GCS of 15/15
with no features of meningeal irritation or craniopathies observed. The motor, cerebella and sensory
functions were intact.
IMPRESSION: - Infantile hydrocele with skin infection.
DIFERRENTIALS:-Congenital hydrocele
-Bilocular hydrocele
-Epididymal cyst
-Hydrocele of the hernia sac
PLAN.
1. Admit the patient to surgical ward.
2. Prepare patient for hydrocoelectomy.
3. Aspirate done and clear fluid was noted from the scrotal swelling.
MANAGEMENT
Investigations:-It is usually clinical diagnosed with no specific investigations. Needle aspiration was done
and clear fluid was obtained.
Treatment
Pre operative management:
-The parents were counseled about the procedure and consent was obtained.
-Hemoglobin level was done which was 10g/dl, and grouping and cross matching revealed blood group
O-positive and a unit of blood was prepared.
-The child was starved for 6 hours before the procedure.
Intra-operative management
Aseptic procedure was observed, under general anesthesia, a Para-inguinal skin crease incision of left
side was made. The sac was identified, sceletonised it, legated high and divided. The abdomen was
closed in layers.
Post-operative management
-Monitor vital signs 2 hourly.
-Analgesic- injection diclofenac 50mg tid for 24 hours.
-i.v ampiclox 250mg 6 hourly for 5/7
-can feed when stable.
-For possible discharge tomorrow.
FOLLOW UP
3rd and 4th September 2010 post-operative day.
The child was in fair general condition, walking around with no major complain and started feeding last
night.
Plan -Discharge home through surgical outpatient clinic to come back after 2/52.
-Syrup ampiclox 7.5mls 6 hourly for 5/7.
-Tabs panadol 250mg tid foe 3/7.
-Tabs albendazole 400mg stat.
DISCUSSION
Introduction
Hydrocele is collection of fluid between two layers of tunica vaginalis of the testis.
The hydrocele fluid is usually amber coloured and sterile as what was obtained from Keneth when
needle aspiration was done.
Infantile Hydrocele
It’s a type of acquired primary hydrocele which does not necessarily appear in infants and thus the case
for Keneth, he was 4 years old.
Here, the tunica and the processus vaginalis are distended to the inguinal ring but there is no connection
with the peritoneal cavity.
Etiology
- Defective absorption of fluid by the tunica vaginalis, probably due to damage to the endothelial
wall by law grade infection.
- Excessive production of fluid as in secondary hydrocele.
- Interference with drainage of fluid by lymphatic vessels of the cord.
- Communication with the peritoneal cavity.
Clinical presentation- It’s usually common in young and the patient may present with the following: -
-History of spontaneous scrotal swelling which can be very big or small depending on the duration.
-Hydroceles are almost invariably translucent except long standing hydrocele becomes non-trans-
illuminant. Keneth’s hydrocele had lasted one year and it was small hence trans-illumination was not
very conspicuous.
-it is also possible to go above it as applied to Keneth’s scrotal swelling.
-Hydroceles are usually fluctuant as it was elicited from Keneth.
Complications of hydrocele
1. Infection.
2. Pyocele.
3. Haematocele.
4. Atrophy of the testis.
5. Infertility.
However, as for Keneth early diagnosis and proper management was done hence did not presents with
any of the above complications.
