PEDIATRICS
■ Infection (epididymitis, orchitis)
■ Testicular trauma
■ Testicular tumor
DIAGNOSIS
Hydroceles can usually be diagnosed clinically. Occasionally, a testicular
ultrasound may be required to rule out other diagnostic possibilities. If there is
clinical concern for incarcerated inguinal hernia, a pediatric surgeon should
be emergently consulted.
TREATMENT
■ 1° hydrocele: Observation only. If a 1° hydrocele persists beyond 2 years of
age, consider referral to a pediatric surgeon for a possible communicating
hydrocele.
■ 2° hydrocele: Management of the underlying process
■ Indirect hernia: Referral to a pediatric surgeon for evaluation of a pre-
sumed indirect inguinal hernia
COMPLICATIONS
■ 2° hydrocele: Progression of underlying process
■ Indirect hernia: Incarceration of bowel loop
Hemolytic Uremic Syndrome
HUS is the leading cause of renal failure in children in the United States.
90% of patients with HUS have diarrhea, most often caused by enterohemor-
rhagicE. coliof the 0157:H7 serotype(produces a shiga toxin causing hem-
orrhagic colitis). Peak age is 9 months to 4 years.
SYMPTOMS/EXAM
■ Prodrome of a abdominal pain, bloody diarrhea
■ HUS develops 2–14 days after start of diarrhea
■ Pallor with petechial or purpural rash
■ Decreased urinary output
■ CNS symptoms (minority of patient): stroke, seizures, coma
DIAGNOSIS
■ Anemia, thrombocytopenia
■ Elevated creatinine, possible hyperkalemia
■ Elevated indirect bilirubin (due to hemolysis)
■ Hematuria often present
■ Stool culture confirms presence of 0157:H7 E. coli.
TREATMENT
■ Avoid antibiotics and antidiarrheal agents in children who have hemor-
rhagic diarrhea(both agents may increase subsequent risk of developing
HUS).
A scrotal mass that
transilluminates does not rule
out an incarcerated inguinal
hernia.HUS triad:- Microangiopathic
hemolytic anemia - Thrombocytopenia
- Renal insufficiency