Syringomyelia in children is caused by excessive accumulation of abdominal fluid into the sphincter through the unclosed syringomyelia. Depending on the location of the abnormal closure of the syrinx, there are basically two types of syringomyelia: spermatic syringomyelia and testicular syringomyelia. Syringomyelia can be seen in all age groups of pediatric patients, the majority of whom are boys, while girls occasionally have syringomyelia, called Nuck’s cyst.
As the syringomyelia continues to occlude after birth and the lymphatic system of the sheath matures, small amounts of fluid can gradually absorb themselves and heal spontaneously. The younger the child, the less fluid there is and the higher the rate of self-healing. In older children, the fluid accumulation is more and the self-healing time is longer.
I. Clinical manifestations
A mass appears in the groin or on one or both sides of the scrotum, which grows slowly and does not cause pain. If the caliber of the unclosed sphincter is thicker, the mass shrinks in the morning after lying down overnight.
II. Examination
1.Local examination The mass is cystic, with positive transillumination test, clear border and no obvious continuity with the abdominal cavity. After squeezing the mass, the tension may be reduced, but there is no obvious volume reduction.
In spermatic sphincter effusion, the mass is located in the spermatic cord and is smaller in size and oval in shape, and the testis can be retrieved under the mass. In testicular syringomyelia, the mass is overhanging the base of the scrotum and is oval or round. If the mass is in high tension, the testicle cannot be found; if it is not in high tension, the testicle can be palpated in the cystic mass.
2.B ultrasound examination shows a cystic mass. It can be distinguished from other intra-scrotal masses (testicular tumor, incarcerated hernia).
Treatment
1.Observation and follow-up In infants and young children, the fluid volume is small and the disease duration is short, it can be observed for 1 year and left to subside on its own.
2.Surgical treatment If no regression is observed or the fluid volume increases within a short period of time and the tension is very high, which may affect the blood circulation of the testis, it is advisable to perform high level sphincter ligation. The surgery is very traumatic, and the conventional incision is only about 1.0 cm. Because of anesthesia, we are usually discharged from the hospital on the first or second day after surgery. Minimally invasive laparoscopic surgery is also possible.
The advantages are
1. the contralateral sphincter can be explored for closure.
2. There is only a needle-eye size incision in the groin and a 0.5 cm incision in the umbilicus, which is more beautiful; however, the disadvantage is that the cost is about 1000 RMB higher than that of conventional surgery, and the fluid in the scrotum and groin needs to be extracted by puncture.
Postoperative complications and prevention
1. Scrotal hematoma The scrotal tissue is loose and prone to bleeding or oozing, so care should be taken to stop the bleeding during the operation.
2. Testicular atrophy is mainly caused by testicular blood flow disorder, and damage to testicular artery should be avoided during surgery, and the tendon membrane of extra-abdominal oblique muscle should be sutured to avoid over-tightening.
3.Scrotal edema Surgical stimulation of the tissue can cause edema, which can subside in a few days after surgery.
4.Vas deferens injury Pay attention to recognize the anatomical relationship.
5.Postoperative recurrence If the position of the ligature is not high enough or the sphincter is torn, it may recur after surgery.
6. Testicular retraction The testicle should be retracted to the bottom of the scrotum during the operation.
Prognosis: The prognosis of pediatric syringomyelia is good after surgery. If the syringomyelia is tense and not operated early, or if the syringomyelia is infected, it will damage the testicular function.