Differential diagnoses: Presentation of groin swellings

Dr Stollery discusses the diagnosis of congenital hydrocoele, hydrocoele, inguinal hernia and inguinoscrotal hernia.

Congenital hydrocoele

Presentation

  • Primary hydrocoele that communicates with the peritoneal cavity via a patent processus vaginalis
  • Soft, fluctuant swelling which transilluminates and affects 1-2% of males
  • Fluid often drains back into the abdomen at night
  • Drainage by digital pressure not usually possible
  • Testis lies within the swelling and cannot be palpated separately

Management

  • Most resolve without surgery in the first year of life
  • Operation the same as hernia surgery, with a herniotomy and excision of the outer layer of the tunica vaginalis

Hydrocoele

Presentation

  • Secondary hydrocoele which develops in later life
  • Causes include trauma, tumour, epididymo-orchitis, torsion, hernia
  • May be associated with oedema from nephrotic syndrome or heart failure
  • Non-tender cystic swelling which will usually transilluminate
  • Testis usually palpable, but lies within the fluid
  • If diagnosis is in doubt, ultrasound can be helpful

Management

  • Once underlying causes excluded, non-communicating hydrocoeles can be managed with scrotal support
  • Therapeutic aspiration may be required for large hydrocoeles, but is not recommended except for elderly men not fit for surgery
  • Surgery usually required for symptomatic communicating hydrocoeles
  • Recurrence uncommon after surgery

Inguinal hernia

Presentation

  • The most common cause of groin swelling, due to protrusion of abdominal contents through inguinal ring
  • May be bilateral, direct or indirect, congenital or acquired
  • 90% occur in males
  • Strangulation may occur, requiring urgent intervention
  • May be associated with pain or aching
  • Swelling increases in size with gravity or when abdominal pressure increases

Management

  • Laparoscopic repair now routine
  • Some cases may require more traditional open surgery
  • In those unfit for surgery, conservative management with a truss can be helpful
  • Recurrence uncommon with laparoscopic mesh repair

Inguinoscrotal hernia

Presentation

  • Groin swelling which extends into the scrotum
  • May be very large
  • Unable to get above the swelling on examination
  • Does not transilluminate and testis palpable separately
  • Swelling usually reducible when patient lying flat and pressure applied
  • Cough reflex usually palpable

Management

  • Management as for inguinal hernia
  • Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Oedema - red flag symptoms

Oedema - red flag symptoms

Red flag symptoms to be aware of when a patient presents with pitting or non-pitting...

Nine in 10 doctors fear NHS staff crisis could force them into mistakes

Nine in 10 doctors fear NHS staff crisis could force them into mistakes

Nine in 10 doctors fear a 'toxic combination' of rising workload and understaffing...

Proportion of GP practices with over 20,000 patients triples in five years

Proportion of GP practices with over 20,000 patients triples in five years

The proportion of GP practices in England with over 20,000 patients has more than...

Government's 'Yellowhammer' plan for no-deal Brexit confirms NHS fears

Government's 'Yellowhammer' plan for no-deal Brexit confirms NHS fears

Medicine shortages and an even tougher winter than usual lie ahead for the NHS should...

How GP trainee numbers in England have soared over the past decade

How GP trainee numbers in England have soared over the past decade

With serious concerns over the falling full-time equivalent (FTE) GP workforce in...

DHSC could shelve pension flexibility plans if Treasury overhauls annual allowance

DHSC could shelve pension flexibility plans if Treasury overhauls annual allowance

Plans to create the 'most flexible NHS pensions ever' could be shelved if the Treasury...