Surgical Conditions

These are bites which are inflicted by animals or humans.

Clinical features

A wound may sometimes be associated with fractures or amputations if inflicted by large animals. There may be bleeding.

Complications
Infection with both aerobic and anaerobic bacteria or viruses.

Treatment

• Clean, debride the wound
• Excise dead tissue
• Leave the wound open for delayed primary or secondary suture

Drugs

• Phenoxymethylpenicillin, adults; 250 -500mg orally 4 times daily, children; 125-250mg orally 4 times daily for 5 days
• Metronidazole, adults; 200-400mg orally 3 times daily, children; 100mg - 200mg orally 3 times daily for 5 days
• Tetanus toxoid, 0.5ml intramuscularly as a single dose.

If the bite is from a suspected rabid animal, administer post-exposure rabies treatment. (Refer to Chapter 2.7).

This is a condition in which the blood flow to an abnormally protruding viscus is compromised. The strangulation can occur in any type of hernia.

Clinical Features

• Abdominal pain
• Fever
• Vomiting
• Irritability
• Restlessness
• Abdominal distension
• Guarding of the abdomen
• Rebound tenderness

Hernia must be differentiated from hydrocele, in the former, the examiner cannot palpate the cord above the mass, whereas with hydrocele normal cord structures are usually palpable above the mass. In strangulated hernia, there is a previous history of a swelling. A hydrocele is often cystic and can be trans-illuminated using a torch.

Diagnosis

• History and examination is very important in making a diagnosis
• Abdominal X-rays

Treatment
The basic line of management is immediate surgical intervention and relieving the obstruction. It is mandatory to inspect the bowel if gangrenous resection is done and anastomose the viable segments.

Drugs

• Benzylpenicillin, adults; 2 MU intravenously 4 times daily, children; 50,000-100,000 IU/kg intravenously in 4 divided doses for 5 days
• Metronidazole, adults; 500mg intravenously 3 times daily, children; 7. 5mg/kg 8 hourly for 5 days
• Gentamicin, adults; 80mg intravenously 3 times daily, children; 2-3mg/kg intravenously in three divided doses for 5 days
• Intravenous fluids

This is a condition characterised by the accumulation of fluid in the tunica vaginalis and it presents as a cystic scrotal mass.

Clinical Features

• Intrinsic, often cystic and painless scrotal mass
• May be painful when severely distended
• Mass is unilateral
• Transluminal mass
• Spermatic cord is palpable above the cystic mass

Treatment

• Hydrocelectomy
• Appropriate antibiotic cover is required

This is a collection of large veins, usually occurring in the left scrotum. It feels like a “bag of worms”. It is present when the patient is in the upright position and should empty in the supine position.

Clinical Features

• Pain
• Feeling of scrotal fullness

Treatment

• Varicocelectomy
• Appropriate antibiotics cover is required