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Abstract: The patient was a 2-year-old boy with a swollen left scrotum since birth, which was diagnosed at that time as a communicating testicular syringomyelia. at the age of 2, the scrotal swelling increased after activity and decreased after sleep. He came to our hospital, and the ultrasound showed that he had a traffic testicular syringomyelia. After the diagnosis was confirmed, a high ligation of the left sphincter was performed under general anesthesia, and the incision healed well after the operation.
Basic information】Male, 2 years old
Disease Type】Traffic testicular syringomyelia
Hospital】Zhengzhou First People’s Hospital
Date of Consultation】October 2021
Treatment plan】Surgical treatment (left sphincter high ligation) + oral medication (cefixime granules)
Treatment period】Inpatient treatment for 3 days, outpatient follow up
Treatment effect] The incision healed well after surgery, and no further scrotal swelling occurred
I. Initial consultation
The child, aged 2, was brought to the outpatient clinic by his parents. Upon questioning, the parents told the child that the left scrotum had been swollen since birth, and the inside was transparent, as if there was water. At that time, the doctor told the child to be observed for half a year and then to seek medical attention, but since the child did not have any major problems, he was left alone. I then let the child stand on the ground and the scrotum was indeed swollen compared to before. The ultrasound result suggested: left-sided traffic testicular syringomyelia. The ultrasound results indicated that the left sphincter of the testis was enlarged.
II. Treatment process
After admission to the hospital, the child underwent preoperative tests such as routine blood, urine, liver and kidney functions, four blood coagulation tests, electrocardiogram and chest X-ray. There were no significant abnormalities in any of the indexes, which were consistent with the surgical requirements. Therefore, a high ligation of the left sphincter was performed under general anesthesia. It was found that the sphincter of the child was the same as the abdominal cavity, which was the reason why the scrotum of the child changed according to the position. The sphincter was ligated so that the scrotum and abdominal cavity were no longer connected, and the operation was successful. After the operation, cefixime pellets were given orally and the scrotum was compressed with gauze, and the swelling decreased significantly after 3 days.
III. Treatment effect
Three days after discharge, the child came to the outpatient clinic again to change the medication and saw that the incision was not red, swollen and oozing, and the scrotal skin was relaxed and not swollen. One week later, the child was re-examined again and saw that the absorbable sutures had come off, the incision was healing well and the scrotum was not enlarged. The parents were very satisfied with the treatment result.
IV. Notes
We are glad that the scrotum of the child is not enlarged after treatment. After the operation of testicular syringomyelia, we should pay attention to avoid letting the child cry for a long time or run down to the ground. This will increase the abdominal pressure, which will increase the pressure at the ligature of the sphincter, which is not conducive to the recovery of the suture, and may even cause the suture to split. Also too much activity with repeated muscle contractions can increase the pressure on the surgical incision and lead to poor healing of the incision. In addition, it will also increase the pressure on the scrotum. Originally, after testicular syringomyelia surgery, the scrotum will have temporary edema, and after the scrotal pressure increases, this edema will aggravate and even lead to the possibility of secondary bleeding.
V. Personal insight
The traffic testicular syringomyelia in the child in this case is a congenital condition caused by the failure of the sphincter to close during fetal life. Generally, the sphincter should be closed before birth, and some of them are closed within half a year after birth, but in this case, the sphincter was not closed at the age of 2, so surgery was recommended. In this case, surgery was recommended because long-term non-closure of the sphincter can cause testicular syringomyelia, and in severe cases, the omentum and intestines can enter the scrotum through the sphincter and form a hernia. Therefore, the family must observe the scrotum of the child after the operation, and if abnormalities are found, they must consult the doctor in time. If it is determined that the testicular syringomyelia is a traffic problem, there is no need to panic until the child is about 2 years old, and if it does not heal itself, the child should go to the hospital for surgery.