hernia and scrotum

8222019 Hernia and Scrotum

httpslidepdfcomreaderfullhernia-and-scrotum 130

983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Clinical Examination ofInguinal Hernia and

Scrotal Swellings

Valentina Lefemine MD MRCS (Eng)

Specialist Registrar in Surgery

All Wales Training Programme



wwwdoctorsacademyorg

Introduction

Patient standing up

Patient lying down




Inspection

Scrotum groin crease groinLOOK for

- Scars (manually part the skin fold)- Asymmetry

- Lumpsswelling in both sides

- Skin Changes




Inspection

Look for swelling in both sides

Cough ndashlook (one side)

Cough ndash look (other side)




Palpation

Scrotum groin

Feel mass testicle

cord structures




Lump ( groin scrotum)

Describe lump Introduction (tenderness site size)

Define (shape surface edges)

Composition (consistency fluctuancepulsatility compressibility reducibility)

Layer of origin (fixity tethering) Overlying surrounding skin




Think

Palpate the scrotum first (even if theswelling is in the groin)

If you can feel a mass in the scrotum ask

yourself

bull Can I get above it

bull Can I feel it separate from the testis

bull Does it transilluminate




Palpation

Can you get above it




If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass

EpididymalcystSpermatocoele




Palpation

Can you feel the testicle separately




If nohellip

Hydrocelehaematocoele

Testicular neoplasia

Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation

Does it transilluminate




If nohellip

Testicular tumour

Hernia




If yeshellip

Hydrocele Epidydimal cyst




If you think the swelling is an herniahellip




Palpation

bull Identify landmarks ASIS pubic tubercle and pubicsymphysis




ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p

i n g u i n a l r i n g ndash e

n t r y

p o i n t o f i n d i r e c

t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t

ASIS ndash anterior superior iliac spine

PT ndash pubic tubercle

PS ndash pubic symphysis

The mid-inguinal point is MEDIAL to the mid-

point of the inguinal ligament

Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve




Very important landmark

Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis

Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here

Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle







Type of hernias

Inguinal hernias emergeabove and medial to the pubictubercle

Femoral hernias emergebelow and lateral to the pubic

tubercle




Palpation

bullPosition yourself to the side of the patient

bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the

other supports the small of the back




Hernia

Cough impulse (not always) Ask patient to reduce it you try if patient

unable

Once reduced Press over external ring ndash cough

Controlled-inguinal hernia

Not controlled ndash femoral hernia

Press over deep ring ndashcough Controlled ndash indirect (80)

Not controlled ndash direct (20)

If you canrsquot reduce it move on







Offer if appropriate

Other groin

Abdominal examination

Per-rectal examination

d t d




Finallyhellip

SUMMARY SENTENCE AND

DIAGNOSIS

d t d




Groin lumpwhat it could be

Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Introduction

Patient standing up

Patient lying down




Inspection




- Skin Changes




Inspection







Palpation

Scrotum groin

Feel mass testicle

cord structures












Think



yourself







Palpation





If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Inspection




- Skin Changes




Inspection







Palpation

Scrotum groin

Feel mass testicle

cord structures












Think



yourself







Palpation





If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Inspection







Palpation

Scrotum groin

Feel mass testicle

cord structures












Think



yourself







Palpation





If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Palpation

Scrotum groin

Feel mass testicle

cord structures












Think



yourself







Palpation





If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you












Think



yourself







Palpation





If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Palpation





If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




If nohellip

Hernia

Infantile hydrocele

(rare)

Varicocele




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




If yeshellip

Testicular mass





Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Palpation





If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




If nohellip



Torsion

Orchitis




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




If yeshellip

Hernia

Varicocele




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Varicocele




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Palpation





If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




If nohellip

Testicular tumour

Hernia




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




If yeshellip









Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you








Palpation





ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




ASIS

PT

PS

M i d - p o i n t

o f t h e i n g

u i n a l l i g a m

e n t D e e p


n t r y


t i n g u i n a l

h e r n i a

M i d - i n g

u i n a l p o

i n t ( m i

d - p o i n t b e

t w e e n A

S I S

a n d P S

) - F e m o

r a l a r t e

r y I n g u i n a l

l i g a m e n t






Inguinal hernia

Femoral hernia

F e m o r a

l v e

i n

Fem

oralnerve














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you














Type of hernias



tubercle




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Palpation







Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Hernia


unable














Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you








Other groin



d t d




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you




Finallyhellip


DIAGNOSIS

d t d





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you





Hernia Lymphnode

Saphena varix

Ectopic testis

Femoral aneurysm

Hydrocoele

Lipoma of the cord

Psoas abscess

983140 983156 983140



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you



983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143

Thank you

hernia and scrotum

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