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Forum Name: Urology Topics

Question: Right testicle is increasing double in size at night


 ashy - Mon Aug 02, 2010 1:30 am

I am 25 year old. I had surgery for appendicitis in 2001-2002. Since past 6 months whenever (infrequent) i had gastric trouble or uncomfortable constipation, I suffer from pain in lower right abdomen for few minutes to hours. Few days back, I had started jogging, one day in the evening I happened to go for 5 miles. That night i had horrible pain and swelling in groin area. It subsided by next morning. Now, frequently i am having pain in lower right abdomen area and sensitivity on Groin area. I also notice every night my right testicle is increasing to almost double the size. Morning times its normal.Please advise me.
 Dr.M.Aroon kamath - Thu Aug 05, 2010 1:37 am

User avatar Hi,
Your symptoms are indeed extremely unusual. The common 'differential diagnoses' will probably include,
- a right sided inguinal hernia("complete" or "inguinoscrotal"),
- a "communicating" hydrocele (one in which the cavity of the sac communicates with the general peritoneal cavity through a often tiny opening).


In the not so distant past, there used to be a prevalent belief that "open" appendicectomy(by causing unintended trauma to the ilioinguinal nerve) predixposes to the development of inguinal hernia on the right side.There is not much evidence for a cause-and-effect relationship at present (although isolated reports of inguinal hernias appearing after appendicectomy have continued to be reported).Inguinal hernias generally tend to REDUCE in size on lying down.

Same goes for the communicating hydrocele as well. This also is expected to REDUCE in size on lying down. Groin injuries related to sports also do not fit in.

As the "common" differential diagnoses have failed to explain your symptoms, we are compelled to look for some rarer conditions and resort to some hypothetical explanations.

a) rare cases of giant urinary bladder diverticuli presenting as contents in a complete inguinal hernia have been reported.
(let us assume that the giant diverticulum does not get filled adequately during the course of the day, due to emptying of the urinary bladder at regular intervals and at night times fills adequate enough to appear as a swelling).
b) a "communicating" hydrocele, with a tiny communication, the opening of which(perhaps, due to the way it is oriented), gets preferentially filled by the peritoneal fluid while lying down. Some "valve-like" mechanism may be contributing as well.
c) "pathological" splenic ruptures have been known to occur in relation to certain kinds of sports (especially while convalescing from infectious mononucleosis ('Mono').
Blood in cases of abdominal trauma (including from a ruptured spleen) has been known to fill a pre-existing patent processus vaginalis sac and present as an acute hydrocele. (Again, for explaining why it would fill only during the nights, we have to resort to the same hypothesis as with communicating hydroceles).
Thank you for this very interesting post.I am frankly, at a loss to offer a plausible diagnosis for your symptom. Nonetheless, i hope it happens to be helpful.
Best wishes!

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