Is Pathological Exam for Disorders of the Appendix Testis Necessary?

2021 ◽  
pp. 000313482110545
Author(s):  
John M. Pickering ◽  
H. William Hunt ◽  
S. Dave Bhattacharya
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Testicular Torsion ◽  
Pediatric Patients ◽  
Standard Of Care ◽  
Acute Scrotum ◽  
Pathological Analysis ◽  
Use Of Resources ◽  
Proven Benefit ◽  
Appendix Testis

Testicular appendages are remnants of embryologic structures commonly encountered during pediatric operations. The literature is vague on the management of incidentally discovered testicular appendages found intraoperatively. We performed a retrospective review of 93 pediatric patients who were found to have an incidental testicular appendage during inguinal hernia repair, cryptorchidism, or testicular torsion cases from December 2017 to June 2020. 100% of the incidental testicular appendage pathology results were benign. All of the specimens were 1.0 cm or less in their largest dimension. Removal of these specimens is considered the standard of care at our institution to help prevent torsion of the testicular appendage, which is one of the leading causes of acute scrotum in children. The authors of this study argue that pathological analysis is unnecessary and may result in excessive use of resources without proven benefit.

scholarly journals Functional testicular torsion secondary to an incarcerated inguinal hernia in a 4-month old: complete recovery at 18-hours

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Gregory M Taylor ◽  
Christian C Strachan
Keyword(s):  
Inguinal Hernia ◽  
Testicular Torsion ◽  
Pediatric Patients ◽  
Complete Recovery ◽  
Cord Compression ◽  
Acute Scrotum ◽  
Indirect Inguinal Hernia ◽  
Incarcerated Inguinal Hernia ◽  
Scrotal Swelling ◽  
Urological Emergencies

Abstract One of the most common urological emergencies encountered in pediatric patients in the emergency department (ED) is the acute scrotum. We present the case of a 4-month-old male that presented to our community ED with scrotal swelling and vomiting of 16-hours duration. He was diagnosed with a functional testicular torsion from an incarcerated inguinal hernia, transferred to a hospital with pediatric urological capabilities and was taken to the operating room ~2 hours later. His hospital course was unremarkable, and he was discharged on day 3, having made a full recovery without any loss of bowel or testicle. There have only been a handful of cases in the literature of a pediatric patient presenting with a functional testicular torsion as a result of spermatic cord compression from an indirect inguinal hernia, with no reported cases of complete salvage at nearly 18 hours since symptom onset.

Comparative Study Between Caudal Block And Local Wound Infiltration In Inguinal Hernia Repair In Pediatric Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Azza Mohamed Shafeek Abdel Mageed ◽  
Wael Reda Hussaein ◽  
Rania Hassan Abdel Hafiez ◽  
Tarek Atef Abdullah Hammouda
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Pain Score ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Caudal Block ◽  
Wound Infiltration ◽  
Unilateral Inguinal Hernia ◽  
Significant Difference

Abstract Background Postoperative analgesia can be provided by a multimodal approach includes opioids, nonsteroidal anti-inflammatory drugs, paracetamol infusion and regional anesthetic techniques such as local infiltration or nerve blocks. In contrast to opioids, local anesthetics can be administered safely and in recent guidelines regional anesthesia is accepted as the cornerstone of postoperative pain relief in the pediatric patients. Objective Compare the postoperative analgesic effectiveness of local wound infiltration of bupivacaine against bupivacaine administered caudally in pediatric patients undergoing unilateral inguinal hernia repair. Patients and methods This study was carried out in Ain Shams University hospitals on 40 pediatric patients of both sexes aged from 6 months to 7 years belonging to ASA I or II undergoing elective unilateral inguinal hernia repair. They were randomly allocated into two groups: group C receiving caudal block, group L receiving local wound infiltration. Hemodynamic changes, postoperative pain score using FLACC pain score, postoperative analgesia and complications were recorded. Results There was no significant difference between the two groups as regard demographic data or hemodynamic variables. Pain score shows no statically significant differences between two groups in the first hour. But statistically significant decrease in FLACC score after (1, 2 and 3 hours) in group C in comparison with group L.decreased significantly in group C after 1 hour postoperative. Duration of analgesia longer in group C with no significant difference in total amount of postoperative analgesia. There was significant increase in incidence in complications in group C than group L Conclusion Caudal block provides better and longer analgesia but requires experience and may lead to complications. In contrast, wound infiltration is simple without significant side effects. Therefore, local wound infiltration may be a preferred technique for producing postoperative analgesia in pediatric inguinal hernia repair.

Approach to Male Urologic Emergencies

2019 ◽  
Author(s):  
Jonathan E. Davis ◽  
Jeffrey S. Dubin
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
Necrotizing Fasciitis ◽  
Testicular Torsion ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Penile Pain ◽  
Emergency Department Setting ◽  
Acute Scrotal Pain

This review details the evaluation and management of the acute scrotum in the emergency department setting and emergent penile complaints in adults, with an emphasis on the most serious and most common conditions. Other emergent conditions include necrotizing fasciitis of the perineum (Fournier disease), incarcerated or strangulated inguinal hernia, and genitourinary (GU) trauma. Emergency practitioners need to be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis. Basic anatomy and bedside evaluation are reviewed. Acute scrotal and penile pain and GU trauma are discussed in terms of assessment and stabilization, diagnosis, and treatment and disposition.  This review contains 5 figures, 19 tables, and 71 references. Keywords: Acute scrotal pain, testicular torsion, priapism, Peyronie disease, paraphimosis, phimosis, balanitis, posthitis, epididymitis

scholarly journals Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

2020 ◽  
Vol 45 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Gözen Öksüz ◽  
Mahmut Arslan ◽  
Aykut Urfalıoğlu ◽  
Ahmet Gökhan Güler ◽  
Şeyma Tekşen ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Parent Satisfaction ◽  
Caudal Block ◽  
Double Blind ◽  
Quadratus Lumborum

Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. In this double-blind prospective randomized trial, we aimed to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries under general anesthesia.Materials and methodsAfter approval was obtained from the ethics committee, in this prospective randomized double-blind trial, 53 patients under general anesthesia undergoing inguinal hernia repair and orchiopexy surgeries randomly received caudal block or QLB. Demographic data, postoperative analgesic requirement, Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 30 min, 1, 2, 4, 6, 12 and 24 hours, parent satisfaction scores and complications were recorded.ResultsThe study included 52 patients, after excluding one patient because of a failed caudal block. There were no significant differences between the groups based on demographic data (p>0.05). The number of patients who required analgesics in the first 24 hours was significantly lower in QLB group (p=0.001). Postoperative 4, 6, 12 hours FLACC scores were significantly lower in the QLB group (p<0.001, p=0.001 and p<0.001, respectively). Parent satisfaction scores were higher in the QLB group (p=0.014).ConclusionAccording to the results of this study, QLB can provide much more effective analgesia than caudal block without adjuvants in multimodal analgesia management of children undergoing inguinal hernia repair and orchiopexy surgeries.Trial registration numberNCT03294291.

scholarly journals Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum

2017 ◽  
Vol Volume 9 ◽  
pp. 169-174
Author(s):  
Naoyuki Fujita ◽  
Mitsuhiro Tambo ◽  
Takatsugu Okegawa ◽  
Eiji Higashihara ◽  
Kikuo Nutahara
Keyword(s):  
Clinical Features ◽  
Testicular Torsion ◽  
Acute Scrotum ◽  
Appendix Testis

The Role of Laparoscopic Evaluation to Detect a Contralateral Defect at Initial Presentation for Inguinal Hernia Repair

2011 ◽  
Vol 77 (11) ◽  
pp. 1463-1466 ◽  
Author(s):  
John M. Draus ◽  
Sarah Kamel ◽  
Aaron Seims ◽  
Frederick J. Rescorla
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Pediatric Patients ◽  
Initial Presentation ◽  
Occurrence Rate ◽  
Processus Vaginalis ◽  
Patent Processus Vaginalis ◽  
Contralateral Patent Processus Vaginalis ◽  
Laparoscopic Evaluation

Our objective was to determine the accuracy of laparoscopic evaluation to detect a contralateral patent processus vaginalis (CPPV) at initial presentation for inguinal hernia (IH) repair and the rate of CPPV relative to age, sex, and initial hernia side. We performed a 5-year retrospective review of 1580 pediatric patients with unilateral IH in which surgeons selectively used laparoscopy to evaluate for a CPPV. There were 1205 boys and 303 girls; 980 (65%) presented with right IH (RIH) and 528 (35%) with left IH (LIH). Laparoscopic evaluation was performed in 459 (47%) patients presenting with RIH and 225 (43%) patients presenting with LIH. Laparoscopic evaluation was positive for CPPV in 32 per cent of patients with RIH and 42 per cent of patients with LIH ( P = 0.0168). CPPV was associated with prematurity ( P = 0.0003) and age younger than 6 months ( P = 0.0001) but not with sex ( P = 0.55). The future contralateral occurrence rate was 1.6 per cent and recurrence rate 0.2 per cent. This study supports the accuracy of CPPV evaluation by laparoscope Although the rate of CPPV decreases after 6 months of age, girls older than 2 years of age have a significantly higher rate of CPPV than boys, supporting laparoscopic evaluation in older girls.

Guidelines for Safe Surgery in Patients with Systemic Mastocytosis

2009 ◽  
Vol 75 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Cassius I. Ochoa Chaar ◽  
Robert L. Bell ◽  
Thomas P. Duffy ◽  
Andrew J. Duffy
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
General Anesthesia ◽  
Umbilical Hernia ◽  
Perioperative Management ◽  
Physiological Stress ◽  
Systemic Mastocytosis ◽  
Standard Of Care ◽  
Hemodynamic Instability ◽  
Umbilical Hernia Repair

Systemic mastocytosis (SM) is a rare disorder with important perioperative implications. The physiological stress of operative procedures and a variety of anesthetic and analgesic medications can be triggers of acute exacerbation of this condition. We present two patients with systemic mastocytosis. One underwent open left inguinal hernia and umbilical hernia repair and the other laparoscopic ventral hernia repair. The literature for perioperative management of patients with SM is extensively reviewed. Both patients were treated preoperatively with intravenous antihistamines and steroids to minimize SM reactions. The first patient underwent uneventful open left inguinal hernia repair and umbilical hernia repair under spinal anesthesia. The second patient underwent general anesthesia. A composite mesh was used to repair a 9 x 12-cm Swiss cheese incisional hernia at the site of previous surgery. After the administration of neostigmine and glycopyrrolate, she developed a generalized rash without any hemodynamic instability. The patient was treated with intravenous Solu-Medrol and Benadryl and was extubated successfully and had an unremarkable postoperative course. Patients with SM require careful perioperative management for surgery under spinal and general anesthesia. These patients can undergo surgical procedures safely and effectively without compromising the standard of care.

scholarly journals Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration

2016 ◽  
Vol 4 (1) ◽  
pp. 89-93
Author(s):  
Aleksandra Gavrilovska-Brzanov ◽  
Biljana Kuzmanovska ◽  
Andrijan Kartalov ◽  
Ljupco Donev ◽  
Albert Lleshi ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Pediatric Patients ◽  
Caudal Block ◽  
Wound Infiltration ◽  
Analgesic Requirement ◽  
Local Infiltration ◽  
Recovery Profile ◽  
The Difference

AIM: The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration.MATERIAL AND METHODS: In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well.RESULTS: The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren’t any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention.CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

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