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Inguinoscrotal disorders

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Inguinoscrotal disorders

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    1. Inguinoscrotal disorders

    2. INGUINOSCROTAL DISORDERS Inguinal hernias Hydroceles Undescended testicles Acute scrotum

    3. INGUINAL HERNIAS INDIRECT DIRECT

    4. INDIRECT INGUINAL HERNIAS

    5. Incidence 1-5% in the general pediatric population M/F ratio is 8:1 to 10:1 In premature infants : the incidence is higher reaching 30%

    6. Associated diseases Cystic fibrosis:15% incidence Connective tissue diseases Mucopolysaccharidosis Children receiving chronic peritoneal dialysis Children with ventriculo-peritoneal shunt

    7. Direct &femoral hernias Very rare Rarely diagnosed preoperatively One third of children with direct hernias have operations for indirect hernias

    8. Clinical presentation Groin bulge extending to the scrotum which usually spontaneously reduces Incarceration Thickened cord

    9. Groin bulge

    13. IRREDUCIBLE HERNIA 12-17% of patients 30% of infants less than 3 months of age Two third of cases occur in the first year of life C/P: pain ;tense swelling: vomiting

    14. Incarceration

    15. Treatment of uncomplicated hernias Operative repair as soon as possible as an elective procedure

    16. HERNIOTOMY

    17. Irreducible hernias Rehydration & resuscitation Sedation & gentle manual reduction followed by operative repair within 24-48 hours- 80% Urgent surgery

    18. hydroceles- Types : communicating :indicating communication with the peritoneal cavity noncommunicating hydroceles: usually resolves with time Abdominoscrotal hydrocele

    20. PRESENTATION SCROTAL SWELLING FLUCUATES IN SIZE TRANSILLUMINANT

    21. TREATMENT SPONTANEOUS RESOLUTION IN 1-2 Y HIGH LIGATION OF THE PROCESSUS VAGINALIS

    22. COMPLICATIONS OF HERNIA &HYDROCELE REPAIR Scrotal swelling Iatrogenic undescended testis Recurrence: 0-0.8% Injury to the vas deferens Testicular atrophy: 1% in elective surgery ; 2-5% in incarcerated hernias Intestinal injury Mortality: very rare

    23. Undescended testis

    24. Incidence Term boys at birth : 3% Preterm at birth : 33% 1% of all boys at the age one year

    25. Classification Palpable testis Nonpalpable testis

    26. Palpable testis True undescended testis Ectopic testis Retractile testis Iatrogenic undescended testis

    27. Perineal testicle

    28. Nonpalpable testis Intraabdominal Absent

    29. Diagnosis Clinical Ultrasound CT- or MRI scan Technetium scan Laparoscopy

    30. Underdeveloped hemiscrotum

    31. Lap. view

    32. Problems with U.D.T Fertility Malignancy Inguinal hernia Torsion Trauma Testicular-epididymal fusion abnormality

    33. Treatment Orchidopexy by the age of one year For nonpalpable testis,laparascopy followed by staged orchidopexy

    34. ACUTE SCROTUM testicular torsion

    35. Differential diagnosis Torsion testis Appendicular torsion Epididymitis/orchitis Trauma Idiopathic scrotal edema Henoch/Schonlein purpura Tumors hernia

    36. Diagnosis Clinical diagnosis Doppler ultrasound Scintigraphy

    37. Treatment Urgent exploration Fixation or excision of involved testis Fixation of the other testis

    38. Prognosis

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