Inguinal scrotal hernia
Presentation
- Scrotal swelling which extends up into the body
- Soft, fluctuant and usually non-tender
- May be reducible when patient is lying flat
- Bowel sounds may be present
- Does not transilluminate when light applied
- May be bilateral or unilateral
- Strangulation may occur, leading to severe pain
Management
- Surgery is the treatment of choice in large, symptomatic cases
- Laparoscopic repair increasingly common
- Support/truss may help where surgery not an option
Hydrocoele
Presentation
- Swelling within the scrotum which is localised and does not extend into the body
- Testes cannot be felt separately as lie within the hydrocoele
- Usually soft, non-tender, cystic
- Transilluminates when light applied
- Caused by excess fluid in tunica vaginalis
- May be congenital or develop later in life
Management
- Most only require reassurance
- Larger ones can be aspirated
- If tumour suspected, aspiration should be avoided - it increases risk of metastatic spread
- In very large or recurrent cases, surgery is usually curative
Angiokeratomas of Fordyce
Presentation
- Small red/purple papules in scrotal skin
- Also found in penile shaft, inner thighs and lower abdomen
- Histologically, composed of ectatic thin-walled vessels in superficial dermis with overlying epidermal hyperplasia
- Scaly surface often present
- Usually 2-5 mm in diameter, although size can vary
- Generally multiple
- May bleed with minimal trauma, otherwise usually asymptomatic
Management
- Treatment not usually required
- Where bleeding occurs, cautery, hyfrecation or laser effective
Steatocystoma multiplex
Presentation
- Uncommon disorder of pilosebaceous unit
- Typically produces multiple sebum-containing dermal cysts
- Can be inherited as autosomal dominant condition, but most cases are sporadic
- Cysts usually non-tender and asymptomatic
- Size can vary from 3mm to 3cm
- Cysts lack punctum and more common in sebum-rich areas
- Secondary infection may occur
Management
- Treatments include cryotherapy, aspiration and surgical excision
- If secondary infection occurs, tetracyclines can be effective
- Dr Stollery is a GP in Kibworth, Leicestershire
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This is an updated version of an article that was first published in November 2014
