A 5-month-old boy is brought to the office for right-sided scrotal enlargement. The enlargement has been present since birth and increases when he cries or strains to pass a bowel movement. There is no history of trauma or infection. The boy's parents do not believe he is in pain and have not noted discoloration of the area. On ultrasonography, the enlargement is found to be a fluid collection around the right testis. The specific embryologic defect giving rise to this patient's condition can also lead directly to which of the following?

Question

A 5-month-old boy is brought to the office for right-sided scrotal enlargement.  The enlargement has been present since birth and increases when he cries or strains to pass a bowel movement.  There is no history of trauma or infection.  The boy's parents do not believe he is in pain and have not noted discoloration of the area.  On ultrasonography, the enlargement is found to be a fluid collection around the right testis.  The specific embryologic defect giving rise to this patient's condition can also lead directly to which of the following?

Quizplus · Accepted Answer

11ec160b_3746_a2db_9249_c134d6613d95_MD0001_00 Early in normal gestation, the testes are located in the retroperitoneal region and subsequently descend into the scrotum before birth. During descent, they are accompanied by an evagination of the peritoneum called the processus vaginalis, which then obliterates after descent is complete. Failure of obliteration of the processus vaginalis leads to a persistent connection between the scrotum and the peritoneal cavity through the inguinal canal. If the opening is small and allows for fluid leakage only, a communicating hydrocele develops. Diagnosis is made clinically through transillumination of the scrotum; a scrotal ultrasound would reveal fluid surrounding the affected testicle. If the communication between the peritoneal cavity and the scrotum is large enough to allow for the passage of abdominal organs, an indirect inguinal hernia develops. Indirect inguinal hernias are common in children. They pass through the deep inguinal ring, are covered by internal spermatic fascia, and are located lateral to the inferior epigastric blood vessels. Hydroceles and indirect inguinal hernias both can present as an asymptomatic scrotal mass that increases in size during Valsalva maneuvers. (Choice A) Direct inguinal hernias are an acquired protrusion of abdominal contents through a weakness of the abdominal wall (Hesselbach triangle). Direct inguinal hernias do not pass through the inguinal canal and are located medial to the inferior epigastric blood vessels. (Choice B) Femoral hernias are an acquired protrusion of abdominal contents through a weakness of the femoral canal. They are the least common type of hernia. (Choice C) Hypospadias occurs due to incomplete fusion of the urethral folds and presents as a ventrally located urethra. (Choice E) Orchitis is a non-specific inflammation of the testes that is classically associated with mumps. In young adults and adolescents, it is commonly caused by Chlamydia trachomatis and Neisseria gonorrhoeae. In older patients, Escherichia coli is the most common causative agent. (Choice F) Testicular torsion is a rotation of the testes around the spermatic cord leading to acute testicular pain. Trauma or a congenitally-horizontal positioning of the testes ("bell clapper deformity") facilitates torsion. Educational objective: Communicating hydroceles and indirect inguinal hernias are caused by an incomplete obliteration of the processus vaginalis. The resultant connection between the scrotum and abdominal cavity can allow for fluid leakage (hydrocele) or the passage of abdominal contents (indirect inguinal hernia). __________ References: Hernias and hydroceles. (http://www.ncbi.nlm.nih.gov/pubmed/24085793)

A 5-Month-Old Boy Is Brought to the Office for Right-Sided