Examination of Groin Swelling
...to the pubic tubercle. B. Differential diagnosis of a Groin Swelling. a. Congenital: Haemangioma. b. Acquired: i. Inflammatory: Infection: acute - acute lymphadenitis - chronic tuberculous lymphadenitis. ii. Traumatic: any haematoma. iii. Neoplastic: 1. Benign: Lipoma (subcutaneous, soft, slipping edge) Fibroma (subcutaneous, firm, moves in all directions). Neurofibroma (subcutaneous, firm, mobility can be elicited in one direction only) Haemangioma ( soft and compressible) 2. Malignant: a. Primary: Lymphoma (Hodgkin’s and Non Hodgkin’s). b. Secondaries in lymph node from a primary carcinoma e.g. Sqamous cell carcinoma or malignant melanoma in skin of lower limb, scrotal skin, perineal skin, anus and skin of gluteal region. iv. Others: 1. Cysts etc: Sebaceous cyst. Psoas Abscess. 2. Autoimmune: 3. Metabolic: calcification of fat or muscle. 4. Artery: Femoral artery aneurysm. 5. Vein: Saphena varix. 6. Nerve: Neurofibroma. C. History taking in Groin Swelling. a. Swelling: i. Onset: Sudden onset in haematoma which occurs after injury. Insidious onset in neoplasm e.g. lipoma. ii. Progression – whether the swelling has remained the same, Whether it has descended into the scrotum or labia (indirect inguinal hernia). Whether the swelling has increased in size (lymphadenitis,abscess,hernia,neoplasms). iii. Reducibility – this means the swelling is a hernia (see notes on examination of hernia. It is usually an inguinal hernia as a femoral hernia is difficult to reduce as it has a very narrow neck). 1. Reduces spontaneously: ask if the swelling reduces spontaenously(as on lying down). Note. In saphena varix there will be a swelling in the groin when the patient stands. However on coughing a thrill can be felt on palpation. The swelling will subside when the patient lies down. 2. Reduces manually. Has a previously reducible hernia become irreducible now and for what duration? Long standing irreducibility means the contents of the hernial sac have become adherent to the wall of the sac. Recent irreducibility of a few hours with pain suggests it may be obstructed or strangulated hernia and requires emergency attention. If there is history of temporary irreducibility at any time but then reduced by itself – this patient needs to be operated early as he may go into complications again and may end up with obstructed or strangulated hernia. . b. Pain: i. Any pain over the swelling – inflammatory conditions like abscess and lymphadenitis will have pain at the onset itself. ii. Pain can be present over a strangulated hernia. iii. In obstructed hernia there will be colicky pain over the abdomen. c. Fever: There will be fever in any inflammatory conditions (abscess and lymphadenitis). d. If there is history of reducibility of the swelling (Hernia) then all the causes of a hernia should be pursued). i. Any history causing raised intra-abdominal pressure. Patient’s occupation involves carrying heavy loads. Chronic cough. Any difficulty in micturition. Chronic constipation. Any abdominal distension suggestive of ascites or tumor? ii. Any history of lower abdominal surgery whereby injury to nerves can leave the abdominal wall muscles weakened re4sulting in inguinal hernia. D. Examination of the Groin swelling. This should be done with the patient standing. Expose the patient from the umbilicus to below the scrotum for good visibility. 1. Inspection: a. Skin is red and shiny in inflammation Discoloration of...