Examination of a Swelling in the Inguinoscrotal region or Groin

COMPLAINTS:

• 1. Pain- Funiculitis is always associated with pain and in fact pain is the presenting symptom in this disease. Tuberculous thickening of the cord, as an extension upwards from the epididymis, is also associated with pain. Malignant extension upward from the testis may be also associated with pain. Vague dragging pain is experienced on prolonged standing in case of a varicocele. Sudden agonizing pain over inguinoscrotal region and in the lower abdomen is complained of in torsion of the testis. On right side this condition often mimics appendicitis. So always examine the scrotum in case of sudden lower abdominal pain.

  2. Swelling- Swelling is the main presenting feature in case of encysted hydrocele of the cord, diffuse lipoma of the cord, lymph varix etc. Interrogations like " How did it appear?" , " Where did it appear first?", "Does it disappear automatically on lying down?" Will give a clue to the diagnosis. A varicocele appears spontaneously whereas a funiculitis starts with fever, ushered in with chill and rigor. An inguinal hernia appears from above whereas an infantile hydrocele, testicular growth and varicocele appear from below. An encysted hydrocele of the cord and diffuse lipoma of the cord appear first in the cord and then gradually enlarge. The commonest place of ectopic testis is the superficial inguinal pouch. The patient will say that the swelling was in that position from the beginning. Undescended testis may give rise to the swelling in the inguinal region from the beginning. A varicocele disappears spontaneously when the patient lies down with the scrotum elevated. A lymph varix also reduces spontaneously on lying down although slower than a varicocele.

  3. Any other complaints- The patient with tuberculous thickening of the cord may present other symptoms like evening rise of temperature, excessive coughing, haemoptysis etc. Rapid onset of varicocele on the left side with haematuria indicates carcinoma of the kidney on that side. Sterility may be complained of in case of bilateral undescended testes (cryptorchidism)

Past History- Previous history of periodic attacks of fever accompanied by pain and swelling of the spermatic cord of scrotum is highly suggestive of filarial infection.

Personal History- History of exposure may be obtained in gonococcal funiculitis.

LOCAL EXAMINATION

Position of the patient-

INSPECTION

• 1. Swelling-

  2. Skin over the swelling-

  3. Impulse on coughing-

PALPATION

• 1. Position & Extent-

  2. Consistency-

  3. Reducibility-

  4. Impulse on coughing-