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Case 127: ?Two hernias

This man presented for treatment of his paraumbilical hernia. He also had a scrotal problem.

1. What is the examiner trying to demonstrate?

That he can 'get above the lump' in the scrotum.

2. How could you confirm the diagnosis?

Physical examination is often all that is required. Transillumination will confirm the nature of the problem as easily as ultrasound will. However, the cause of the hydrocoele may occasionally be due to an underlying testicular tumour and an ultrasound here is important.

3. The scrotal problem does not cause him any trouble. Do you think it needs treatment?

No. As long as a sinister underlying cause is excluded the patient can be reassured and observed as to the size of his hydrocoele. As a rule, if a patient does not have any problems attributable to a benign condition, do not offer to 'help' by suggesting surgery.