|IMAGES IN SURGERY
|Year : 2015 | Volume
| Issue : 3 | Page : 172-173
"Scrotal pearl" or calculus in hydrocele
Ankit Shukla, Ramesh Bharti, Rakesh B Anand
Department of General Surgery, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India
|Date of Web Publication||1-Dec-2015|
Senior Resident, Department of General Surgery, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
"Scrotal pearl" or calculus in the hydrocele fluid is found incidentally during an operation, ultrasound or clinical, if large in size. The exact etiopathogenesis of the disease is not clear but is linked to inflammation, injury, necrosis, and infections by parasites. It is a benign asymptomatic condition and a rare complication of hydrocele. A stone in hydrocele does not change the management or prognosis; however, if the stone is adherent to the tunica albuginea and does not change position on ultrasonography the possibility of a tumor has to be borne in mind.
Keywords: Calculus, hydrocele, scrotal pearl, stone
|How to cite this article:|
Shukla A, Bharti R, Anand RB. "Scrotal pearl" or calculus in hydrocele. J Med Soc 2015;29:172-3
| Case Report|| |
A 55-year-old gentleman presented with a left scrotal swelling. He had a history of discomfort and mild pain while walking. Physical examination of the patients revealed a 6 cm × 5 cm cystic, fluctuant, transilluminant swelling without cough impulse. There were multiple small sebaceous cysts on the scrotal skin. Left testis was not separately palpable. The patient was planned for Jaboulay-Winkelmann procedure. After incising the tunica vaginalis, 150 mL of an amber-colored, nonmalodourous fluid was evacuated. Tunica vaginalis was thickened with adhesions to testis, and a small round, 0.5-cm sized, nonadherent white stone with smooth surface was found in the hydrocele [Figure 1]. The patient recovered and the postoperative period was uneventful.
| Discussion|| |
In 1935, Kickham was the first to describe intrascrotal calculus during an operation as a "fibrinoid loose body" or "scrotal pearl". , Reported incidence of scrotal calculi in the literature is 4.3%.  Usually, the stones are less than 1 cm in size; however, they can be of larger sizes as well. The precise etiopathogenesis of this disease is not known and is linked to inflammation, injury, necrosis, and parasites (filarial). These calculi may develop from remnants of the appendix testis or appendix of epididymis after their torsion and become freely movable in the hydrocele fluid.  Frauscher et al. have reported that there is high prevalence of scrotal calculi in extreme mountain bikers most probably due to the chronic microtrauma of scrotal contents, from shock and vibration of the saddle from the rough terrains.  Clinically these calculi are asymptomatic and palpable only if large or very scant amount of fluid is present in the hydrocele. Most of the calculi are found incidentally during surgery for hydrocele or on sonography.
Introduction of ultrasound has led to increase in diagnosis of this rare entity with high frequency transducer ultrasonography. It is the investigation of choice showing the movement of hyperechoic lesion in the fluid between the tunica, with discrete acoustic shadow. ,, However, differentiation from testicular tumor becomes important if the stone is adherent to the tunica albuginea and does not change its position.  The stones are usually composed of carbonate apatite or magnesium ammonium phosphate.
In our case, the calculus in the hydrocele was found incidentally during surgery, with thickened and adherent tunica signifying inflammation, which might have been the underlying etiology of the formation of calculus. Although calculus in hydrocele does not change the management or prognosis, if the stone is adherent to the tunica and does not change position on ultrasonography, there is a possibility of a tumor.
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Conflicts of interest
The authors declare that there is no conflict of interest regarding the publication of this paper.
| References|| |
Kickham CT. Calcified hydrocele of the tunica vaginalis testis: Case report. N Engl J Med 1935;212:419.
Linkowski GD, Avellone A, Gooding GA. Scrotal calculi: Sonographic detection. Radiology 1985;156:484.
Namjoshi SP. Calculi in hydroceles: Sonographic diagnosis and significance. J Clin Ultrasound 1997;25:437-41.
Frauscher F, Klauser A, Stenzl A, Helweg G, Amort B, zur Nedden D. US findings in the scrotum of extreme mountain bikers. Radiology 2001;219:427-31.