How to differentiate between Inguinal hernia and hydrocele?-Dr. Prashant Jain
Location: (Delhi)
Inguinal hernia is usually a reducible swelling with cry/cough impulse while a hydrocele is a tense cystic, clinically irreducible swelling without any impulse. Transillumination test is not reliable as can be present in both the cases. Why hydrocele is irreducible swelling?
The pathogenesis of both hernia and hydrocele is same that is persistence of processus vaginalis.
The neck of hydrocele is very narrow and so even if you try to compress the swelling, the fluid from processus vaginalis will not go into the abdominal cavity. The parents will give a characteristic history of swelling being less during morning and then gradually starts increasing in size. While the opening of hernia sac is large enough to allow the free reduction of contents.
For how long one can safely wait in hydrocele?The hydrocele which are constant in size through out the day time are usually scrotal type hydrocele and are seen in newborns. They are called as non- communicating hydroceles. It is this type of non -communicating hydrocele which tends to resolve spontaneously.
The hydrocele in which parents gives the history of increase and decrease in the size of swelling are called as communicating hydrocele and will require surgery.
The condition can be safely observed till 18mths to 2 years of age as it is harmless. But one should be sure that they are not associated with hernia.
When one should advice for hernia surgery?Inguinal hernias never go away without surgery. This is a condition in which surgery is advised to be done as early as possible as the risk of hernia getting incarcerated is as high as 30 to 40%. If not tackled in time it can lead to major complications of gut and testis necrosis. Also emergency anesthesia may further increase the risk for the child.
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