The Case of the Mysterious Mass. Andrew Williams Ken Koncilja Aravind Reddy Meghan Kaumaya. Patient and Chief Complaint. 12 year old male with walnut size enlargement left of pubic tubercle Enlargement changes with body position and activity level
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Temperature: 98.4 F
Respiratory Rate: 15
Weight: 110 lbs.
Abdomen: Small palpable mass in groin, lateral to pubic tabercle
Neurological: NormalPhysical Exam
Contains 3 layers
External spermatic fascia: from external oblique muscle
Cremasteric muscle: from internal oblique muscle
Internal spermatic fascia: from transversalis fascia
Leaves abdominal cavity lateral to inferior epigastric vessels
Enters deep inguinal ring and runs inside spermatic cord
Sac formed from persistent processus vaginalis
Leaves abdominal cavity medial to inferior epigastric vessels, through inguinal triangle
Travels through medial portion of inguinal canal, runs parallel to spermatic cord
Sac formed by peritoneum and transversalis fascia
Processus Vaginalis does not seal after the descent of the testes
Fluid or intestines occupy the space in the inguinal canal left open by the patent processus
The processus vaginalis remains patent in 25% of adults
Indirect are far more common in younger males
Exercise or strain can induce a direct hernia
Direct Hernias are more common in males over 40
Problem lies in a weak falx inguinalis (conjoint tendon) either by trauma or lack of exercise.Congenital or Acquired?