Funiculitis (etiology, classification, clinical signs and treatment). Granuloma of the spermatic cord. Post-castration edema (oedema postcastrationem). Focal cystic lesions

Spermatozoal granuloma occurs mainly before 30 years of age. The epididymis of the right testicle (its head and body) is more often affected, in about 14% of patients - both epididymis. Most often, spermatozoal granuloma occurs as a result of a previous inflammatory process in the ducts of the epididymis, after damage to the vas deferens, or as a complication after resection spermatic cord, plastic surgery undertaken to restore the patency of the vas deferens in case of obstructive azoospermia (see full body of knowledge). Inflammatory changes in the epididymis of a specific or non-specific etiology are usually the main condition predisposing to the development of Spermatozoal granuloma Approximately 50% of patients simultaneously with Spermatozoal granuloma in the epididymis show a tuberculous process, in 30% - nonspecific epididymitis (see full body of knowledge). Due to cicatricial narrowing of the ducts of the epididymis, their patency is disturbed, stasis of the contents occurs, and then focal destruction of the epithelial cover and basement membrane of the ducts, which contributes to the penetration of spermatozoa into the surrounding interstitial tissue. It is also possible to develop spermatozoal granuloma due to an aseptic inflammatory process. In the tissue of the testis, spermatozoal granuloma occurs with the so-called granulomatous orchitis (see full body of knowledge).

Morphologically, three stages of development are distinguished. Spermatozoal granuloma In the first stage, spermatozoa and seminal fluid penetrate from the ducts of the epididymis into its tissue. In the second stage, a granulomatous reaction occurs in the epididymal tissue around the spermatozoa and seminal fluid that have penetrated into it, which is expressed in the accumulation of leukocytes, epithelioid, plasma and giant cells, as well as macrophages that phagocytize spermatozoa. The maturing granulation tissue (see full body of knowledge) is enriched with collagen fibers. In the third stage, scarring of the granuloma occurs, while along its periphery there is lymphoid infiltration and fibrosis, the severity of which depends on the duration of the process.

The affected epididymis on the section is white-gray with yellow-brown foci, along the periphery the consistency of the epididymis is softer than in the center. The sick are worried aching pain in the scrotum, aggravated by walking and ejaculation. The epididymis, rarely the testicle itself, gradually increase. Palpation reveals a dense, painless infiltrate ranging in size from 3-5 millimeters to 7 centimeters. In 1/3 of patients, the appendage becomes tuberous. At the same time, the spermatic cord is compacted or clearly changed. Most patients have signs of tuberculous or nonspecific epididymitis.

The diagnosis is established by histological examination of the material obtained by biopsy.

Differential diagnosis is carried out with tuberculous and nonspecific epididymitis (see the full body of knowledge), malacoplakia (see the full body of knowledge), neoplasms of the epididymis and the testicle itself (see the full body of knowledge).

Treatment is mainly surgical: epididymectomy is performed (excision of the epididymis). With spermatozoal granuloma of the testicle, according to indications, resection or removal of the testicle is carried out. With spermatozoal granuloma of the vas deferens, resection of the affected area of the duct is necessary with end-to-end anastomosis.

The prognosis for reproductive and sexual functions with a unilateral lesion is favorable.

MAIN PROVISIONS

Extratesticular pathology of the scrotum is mostly benign.

Adnexal adenoma-like tumor is the most common solid extratesticular tumor.

Differential diagnosis between spermatocele and epididymal cyst has no clinical significance.

Spermatogenic granulomas are mainly the focus of attention in patients with a previous history of vasectomy.

When assessing a suspicious palpable lesion on sonography, the examiner should palpate the lesion and determine its density, as well as adjust the direction of the examination.

Due to the ascending nature of the infection, epididymitis can usually be limited to the tail of the epididymis, so this area should be carefully assessed during ultrasound if acute epididymitis is suspected.

When evaluating predicted hernias and varicoceles, provocative tests are usually required; performing a Valsalva maneuver by the patient may be sufficient, but in some cases, an examination in an upright position is necessary to better demonstrate the pathology.

INTRODUCTION

The extratesticular structures of the scrotum include: appendages, spermatic cord, own fascia, which develops during the descent of the testicles during their embryonic development through abdominal wall into the scrotum. The epididymis is a crescent-shaped structure that lies along the posterior margin of the testis, connecting the efferent seminiferous tubules in the testis with the vas deferens.

The efferent ducts pass through the albuginea and merge to form the head of the epididymis. Then the tubules unite, passing along the edge of the testicles, and form the body and tail of the epididymis, which are attached to the lower pole of the testis by a loose connective tissue. The tail continues further as the vas deferens. The vas deferens forms a loop at the top of the spermatic cord to join with the duct of the seminal vesicles and forms the ejaculatory duct, which empties into the urethra.

Knowledge of these anatomical features is very important for understanding the retrograde spread of infection along the above pathways and, as a result, the development of epididymo-orchitis.

The spermatic cord contains blood vessels (including an interconnected network of small veins, the pampiniform plexus), nerves, lymphatic vessels, and connective tissue away from the vas deferens.

High-resolution color Doppler or power Doppler sonography is the modality of choice for imaging patients with scrotal pathology. This method also shows good reliability in the differential diagnosis between intratesticular and extratesticular lesions.

In addition, sonography is very effective in describing extratesticular pathology such as cystic or solid masses, which is important feature to assess such lesions. Most extratesticular lesions are benign, although about 5% are malignant.

TECHNIQUE AND SONOGRAPHIC ANATOMY

Although a detailed review of the sonographic technique has been described in another article by Vijayaraghavan, “Testicular Sonography”, several key points that improve the visual assessment of extratesticular components will be considered in this review along with the normal ultrasound anatomy of these structures.

The initial task in assessing extratesticular anatomy is to identify the head of the epididymis (globus major), usually on the upper surface of the testicles; this is usually best achieved in the longitudinal plane (Fig. 1).

Rice. one. Normal adnexal head. Sonography (longitudinal view) shows the testicles and head of the epididymis (arrow).

Once the head of the epididymis is in view at the top of the screen, the lower part of the transducer is gently rotated laterally or medially to locate the body (corpus) and tail (globus minor) of the epididymis, thus displaying the epididymis as a single elongated shaped structure. crescent (Fig. 2).

Rice. 2. Normal body and appendage tail. (A) Longitudinal sonography of the body of the epididymis (arrows). (B) Oblique sonography showing the convoluted tail of the epididymis (between arrows).

Sonographically, the epididymis is isoechoic or slightly more echogenic than the testicles themselves, with slightly coarse echotexture. Head sizes vary from approximately 10 to 12 mm in diameter. The body and tail are usually somewhat less echogenic than the head and are usually less than 4 mm in diameter. The transducer is then moved downward to assess the region of the tail and visualize the epididymal differential loop, where the tail of the epididymis and its convoluted tubules transform into the vas deferens (Figure 3).

Rice. 3. Epididymodifferential loop.

The epididymodifferential loop is where the tail of the epididymis passes into the convoluted tubules, which are the vas deferens (arrows). The vas deferens makes a 180-degree turn and then follows cranially at the level of this junction.

The vas deferens can be traced up to the area of the spermatic cord and re-evaluated in longitudinal and transverse views. The vas deferens is generally donut-shaped in transverse view, but is incompressible and less than 0.5 mm in size (Fig. 4).

Rice. 4. Deferent duct. Longitudinal (A) and transverse (B) sonogram of the vas deferens (arrows) at the root of the scrotum within the spermatic cord. The vas deferens has the form of a tramway in the longitudinal plane, with a thick hypoechoic wall and a central anechoic lumen; it looks like a "doughnut" in the transverse plane, with a target-like appearance.

Additional examinations are carried out on the medial and outer side of the testicles to determine the presence of any formations or accumulations of fluid.

Doppler ultrasound is used to assess the presence or absence of blood vessels. This is particularly useful for determining adnexal blood flow as well as for evaluating varicocele.

EXTRATESTICULAR LESIONS

Dropsy, hematocele, pyocele are collections of fluid, blood and pus that are located between the visceral and parietal plate of the vaginal membrane, known as the scrotal sac (scrotum). The visceral layer of the vaginal membrane merges with the albuginea. A small amount of fluid in the scrotum is normal and is detected by sonography in 86% of men, without any symptoms.

Most congenital hydroceles are formed by passive accumulation of fluid formed in the abdominal cavity. After 18 months, after complete closure of the vaginal process, the fluid is absorbed. An acquired hydrocele may be secondary to inflammation, trauma, or tumor. Uncomplicated edema is easily visualized by sonography and is usually anechoic (Fig. 5), or with a slight, poorly echogenic suspension of cells or cholesterol crystals (Fig. 6).

Rice. five. Big dropsy. (A, B) Sonogram of the left half of the scrotum with the transducer along the anterior wall of the scrotum (A) and rear wall scrotum (B). Sonogram showing a large hydrocele covering most testicles, except for the part where the testicle is fixed to the wall of the scrotum.

Rice. 6. Dropsy with an internal slight, slightly echoic (arrow) suspension of cells or cholesterol crystals.

Rice. 7. Hematocele. Thin partitions (arrows), represented by fibrin strands, form transverse accumulations of fluid.

Hematocele (Fig. 7) usually refers to trauma or pyocele (Fig. 8) caused by an infection. They have internal echoes, often with multiple partitions, cellularity, and sometimes intramural calcification.

Rice. 8. Pyocele. Gray scale sonography (A) and color Doppler sonography (B) show an edematous testis (A) and a hypervascularized epididymis (B) surrounded by fluid in the scrotum containing several thin internal septa. With this clinical picture of epididymo-orchitis, the diagnosis of pyocele most likely takes place.

VARICOCELE

Varicocele is the term for dilated veins of the pampiniform venous plexus, which is described on palpation as a "bag of worms" when medical examination. The veins of the pampiniform plexus usually range from 0.5 to 1.5 mm in diameter, with a maximum size of up to 2 mm. Historically, varicocele has been grouped into categories based on how it was detected; a varicocele larger than 5 mm in diameter is always sufficient to detect it on physical examination, and such a varicocele is called a clinical varicocele. A subclinical varicocele is a condition in which the pampiniform plexus of veins is enlarged but not palpable. Although there is controversy among experts, a subclinical varicocele is generally considered to be enlargement of the pampiniform plexus veins greater than 2.5 mm in diameter at rest or greater than 3 mm in diameter on a Valsalva maneuver or other provocative tests, such as a standing examination. . Venous dilatation in a varicocele is usually limited to the pampiniform plexus, but can also extend to the testicles (a common cause of testicular atrophy), which is called an intratesticular varicocele.

Primary varicocele is always caused by reflux of the pudendal vein, which is associated with its valvular insufficiency, resulting in venous congestion and dilatation of the vein itself. Dopplerography is an effective method for detecting reflux during the Valsalva maneuver, and the study can also be supplemented by performing reflux in a standing position. Primary varicocele most often develops on the left due to the anatomical connection of the left testicular vein with the left renal vein, into which it flows at an angle, which contributes to the development of reflux, while the anatomy of the right testicular vein allows blood to flow freely into the inferior vena cava at an acute angle, which to a lesser extent stimulates the development of reflux (Fig. 9).

Rice. nine. Varicocele. Gray scale image (A) at rest and color Doppler image (B) during Valsalva maneuver. These images show dilated paratesticular veins, additional venous flow during the Valsalva maneuver, reflecting gonadal venous reflux in varicocele.

Secondary varicocele develops as a result of obstruction of blood flow in the testicular vein; it happens as a result external pressure to veins due to several causes, including: severe hydronephrosis, tumors or neoplasms of the abdomen or retroperitoneum, and inguinal hernia. The presence of a right-sided varicocele should raise the suspicion of primary cause this disease, which requires an examination of the inguinal region and retroperitoneal space to exclude tumors or malignant neoplasms (Fig. 10).

Rice. 10. Right sided varicocele. (A) Volumetric process in the lower pole of the right kidney. (B) Infiltration of the inferior vena cava (IVC) by a thrombus (double asterisk). (C) Dilated veins along the posterior and medial surface right testis secondary to IVC thrombosis (arrows).

Scrotal hernia

A scrotal hernia can be presented as an extratesticular formation of the scrotum. On sonography, the appearance of peristaltic bowel loops, with their characteristic folds or haustrations, aids in making the diagnosis (Fig. 11).

Rice. eleven. Hernia. Longitudinal sonogram of the scrotum shows the testis, which is located in the lower part, displaced by fluid-filled loops of the intestine and the fluid itself (arrows). During the surgical operation, the diagnosis of strangulated inguinal hernia was confirmed.

However, scrotal hernias may contain only fatty tissue of the mesentery or omentum (Fig. 12), which are difficult to distinguish from fatty tumors of the spermatic cord (usually lipomas). In such cases, careful ultrasound procedure using provocative tests, such as the Valsalva test, can help in the diagnosis by provoking telescopic movements of the hernial contents.

Rice. 12. Adipose tissue in the hernia. A scrotal hernia containing a hyperechoic omentum/mesentery (A). The presence of adipose tissue was confirmed in computed tomography(CT) (B).

DENSE EXTRATESTICULAR LESIONS

The most common extratesticular tumor of the scrotum is an adenoma-like tumor. This benign tumor is of connective tissue origin (mesothelial origin). Adenoma-like tumors account for 30% of all extratesticular tumors. Patients are usually male between the ages of 20 and 50.

These tumors are often located in the tail of the epididymis, although they can also develop elsewhere in the epididymis, in the spermatic cord or testicular membrane. These tumors are mostly unilateral, solitary, well-circumscribed, and have multiple ultrasound findings. However, most tumors that occur in the epididymis are hypoechoic, well-circumscribed, or oval formations(Fig. 13, A), usually with some internal vascularity, as confirmed by color Doppler. Adenoma-like tumors arising from the testicular membranes are typically lenticular in shape (see Fig. 13B), often hyperechoic, and may have reduced vascularity.

Rice. 13. (A) Adenoma-like tumor. (Left) Gray scale doppler imaging of the testicles shows well-defined, slightly patchy lesions in the lower scrotum, located extratesticularly and without internal blood vessels. (Right) The formation (asterisk) is located in the tail of the appendage. (B) Adenoma-like tumor from the testicular lining. Both images (left and right) show longitudinal and transverse views of testicles with a lenticular hyperechoic focal lesion, which is an adenoma-like tumor that develops from albuginea.

The location of these sheathing adenoma-like tumors on the surface of the testis may mimic peripheral testicular tumors or tumor invasion into the adjacent testis, although these tumors are non-invasive and have a benign histology. Among extratesticular tumors, lipomas are the most common formations that develop from the spermatic cord. Ultrasound signs These lipomas are similar to those found elsewhere in the body and are usually hyperechoic or have hyperechoic striation. Lipomas of the spermatic cord, as a rule, are located laterally in the thickness of the spermatic cord. With large lipomas, it can be difficult to distinguish a benign lipoma from a liposarcoma (Fig. 14).

Rice. 14. Liposarcoma. Longitudinal gray scale sonogram (A, B) of the left inguinal canal and scrotum shows a large echogenic mass (arrow) with poorly defined margins.

Other benign tumors include: fibromas (Figure 15), hemangiomas, leiomyomas (Figure 16) and neurofibromas.

Rice. 15. Sheath fibroma. Gray scale sonogram (A) and color Doppler image (B) show a round, well defined tunica albuginea lesion with testicular tumor effect. There is minimal vascularization. A significant attenuation of the ultrasonic wave (arrows) with the development of a distal shadow is determined.

Rice. 16. Leiomyoma of the epididymis. Gray scale sonogram (A, C) and color Doppler image (B) show the typical whorled pattern of extratesticular leiomyoma. Figure C shows the proximity of the leiomyoma to the rest of the tail (epi) of the epididymis.

Extratesticular papillary cystadenoma is a rare pathology that can be observed in patients with Von Hippel-Lindau disease. Two-thirds of men with papillary cystadenoma have Von Hippel-Lindau disease (Figure 17).

Rice. 17. Papillary cystadenoma. This tumor is slightly lobulated, of mixed echotexture, firm (arrow), located in the head of the adnexa with internal vascularity. The data of papillary cystadenoma were confirmed by post-mortem examination.

These tumors can vary in size from 1 to 5 cm and are usually solid.

Primary extratesticular malignant neoplasms scrotum include: fibrosarcoma, liposarcoma, histiocytoma, and lymphoma. Extratesticular metastases of the scrotum are very rare. Children may develop rhabdomyosarcoma.

Spermatogenic granulomas are benign lesions of the epididymis that result from a granulomatous reaction to extravasation of spermatozoa into the soft tissues that surround the appendage. These lesions can be painful and may also be associated with primary infection, trauma, or vasectomy. These granulomas typically appear on sonography as solid, heterogeneous masses with obvious signs of internal vascularization (Fig. 18).

Rice. eighteen. spermatogenic granuloma. The gray scale image (A) and color Doppler (B) in longitudinal projection through the scrotum show slightly heterogeneous lesions of the tail of the epididymis.

Fibrous pseudotumors are rare reactive fibrous proliferative inflammation of the epididymis and/or vaginal membrane. These pseudotumors may be hyperechoic or hypoechoic; characteristic features include little or no vascularity complete absence internal vascularization, as well as a significant attenuation of the ultrasound wave (Fig. 19).

Rice. 19. Extratesticular fibrous pseudotumor. The sagittal sonogram shows an elongated hyperechoic paratesticular nodule (arrow), which is indicated by crosses.

Accessory adrenal glands (Marchand's organ), which hypertrophy in patients with congenital adrenal hyperplasia, are also rare lesions and are also characterized by significant attenuation of the ultrasound wave. Although most accessory adrenals are intratesticular, they can also be extratesticular. The combination of hypoechoic intratesticular and extratesticular lesions, especially when there is significant attenuation of the ultrasound waveform, should raise the suspicion of accessory adrenal glands, which occur only in patients with congenital adrenal hyperplasia (Fig. 20).

Rice. twenty. Accessory adrenal gland (Marchand's organ). Sagittal sonogram of the right scrotum (A, B) shows a round, slightly hypoechoic lesion adjacent to the testis (A) and another lesion in the testis (B) that is characteristic of an accessory adrenal gland in a patient with congenital adrenal hyperplasia. Axial CT (C) showing enlarged lobular adrenals in the same patient.

FOCAL CYSTIC LESIONS

Cystic structures are usually found in the epididymis and are asymptomatic in 20-40% of cases. Spermatocele, which are enlarged, fluid-filled spaces containing spermatozoa, is quite common and is caused by obstruction and subsequent dilation of the epididymal tubules. These lesions are usually located in the adnexal head and usually have a low level of internal echo and may present as a constantly moving object (Fig. 21).

Rice. 21. Small adnexal cyst. (A) Longitudinal view through the head of the adnexa shows a well-defined, nonvascular, anechoic cyst consistent with an adnexal cyst. (B) Oblique color Doppler of the left epididymis shows a small round lesion with low internal echo but no internal blood flow, suggesting a cyst. This cyst can be either a spermatocele or an epididymal cyst, but the presence of a low-level internal echo indicates a more likely diagnosis, a spermatocele.

The spermatocele can become large, fill the scrotum and mimic a large hydrocele. One of the main ultrasound features to differentiate a large spermatocele (Fig. 22) from a hydrocele is whether the fluid completely envelops the testicles (as would be the case with a hydrocele) or mimics a tumor-like effect near the testicles (which would be a predictor of spermatocele).

Rice. 22. Spermatocele. Transverse (A) and sagittal (B) sonograms of the left half of the scrotum show large cluster baffled liquids, low level echo, located next to the testicles, which are partially shown in the picture. (A) Fluid does not completely envelop the testis, as would be expected in a hydrocele. The patient had no history of trauma or infection, and the appearance of this extratesticular large cystic mass is consistent with the development of a spermatocele.

Epididymal cysts are also characteristic lesions. These cysts do not contain spermatozoa and therefore do not have an internal echo; otherwise, ultrasound distinction between epididymal cysts and spermatocele is not possible. This differentiation is not as important clinically, and these terms can be used interchangeably and are used historically when describing findings.

Cysts may arise from the albuginea and are usually small and variable in number. These cysts are less common than testicular cysts, with an incidence of 0.3%. Cysts of the albuginea are benign. Their significance lies only in the fact that they raise the suspicion of the presence of a neoplasm of the testicles on physical examination.

ACUTE EPIDIDYMITIS

Acute epididymitis is the most common cause acute scrotal pain in adult men.

Infection usually results from retrograde spread of the infectious organism from the prostate or bladder through the vas deferens. As a result, the process usually begins in the epididymis (often the tail), before involving the entire epididymis (Fig. 23), and may subsequently progress to involve the testicle (epididymo-orchitis) (Fig. 24).

Rice. 23. Epididymitis. Oblique sonography (A) shows enlarged and heterogeneous adnexae, with hyperemia, as shown in the color Doppler image (B). There are no focal avascular areas on the image that would indicate abscess formation.

Rice. 24. Epididymoorchitis. Color Doppler images of the central testicle (A) and enlarged epididymis (B) show profuse hyperemia, reflecting inflammatory changes in this patient with epididymo-orchitis. Nearby, there is reactive hydrocele and thickening of the skin adjacent to the process, which is a characteristic pathology-related process.

Gonococci and chlamydia are the most common cause of epididymitis in men under the age of 35; in older men, E. coli, other colibacilli and different kinds Pseudomonas are more characteristic pathogens.

Universal ultrasonic features Epididymitis and epididymo-orchitis are hyperemia of the affected structures. In fact, increases in color flow shown on a color Doppler scan may precede any grayscale anomalies, as in one study demonstrating normal structure in grayscale in 20% of cases of epididymitis. On grayscale sonography, epididymitis is usually referred to as an increase or decrease in the echogenicity of the epididymis, although with higher frequency transducer and newer technology, significant heterogeneity in the echogenicity of the inflamed epididymis is increasingly common. Enlargement of the epididymis is usually diffuse, but may be focal in 20-30% of all cases. Due to the “ascending” course of infection, local epididymitis is usually associated with the tail of the epididymis. With the progression of inflammation in the testicles, the latter become diffusely enlarged and hypoechoic. Other symptoms may include reactive dropsy and skin thickening (Figure 25).

Rice. 25. Thickened skin of the scrotum. Transverse projection of a color Doppler examination of the scrotum shows enlargement and hyperemia of the left testicle compared with right side. A thickening of the scrotal wall is also shown, with hyperemia of the overlying inflamed left testicle.

Severe infections may lead to the development of a local testicular or epididymal abscess (Figure 26) or a generalized intrathecal pyohydrocele. These accumulations of pus require urgent surgical intervention to prevent more extensive intrascrotal necrosis. These abscesses appear as local accumulations of fluid with internal echogenic inclusions and cellular debris. Gas formation is uncharacteristic. Color Doppler ultrasonography may be useful in identifying non-vascularized hypoechoic areas with peripheral vascularity in inflamed intrascrotal tissues that are suspicious of an abscess.

Rice. 26. Abscess of the epididymis. Longitudinal sonography (A) of the adnexal tail shows diffuse enlargement of the central rounded area with altered echogenicity. Color Doppler ultrasonography (B) shows increased blood supply to the enlarged tail of the epididymis, which is characteristic of reflective epididymitis. The central avascular zone is a frolicking small abscess.

Fournier's gangrene (Fig. 27) - necrotizing fasciitis, which develops in people with weakened immune systems or diabetes. Sonography makes it possible to identify necrotic areas of the skin and the presence of gas, which is manifested by hyperechoic foci with distal shading.

Rice. 27. Fournier's gangrene. Sonography of the scrotum in a diabetic patient with Fournier's gangrene shows significant thickening of the scrotal wall posteriorly and laterally. The echogenic zone, with the so-called dirty shadow, is a gas that accumulates in the affected area.

CHRONIC EPIDIDYMITIS

Patients with granulomatous infections may present with firm, painless masses due to adnexal enlargement as seen on sonography (Figure 28).

Rice. 28. Sarcoidosis. Sagittal (A) and transverse (B) sonogram in a patient with sarcoidosis shows a heterogeneous extratesticular tumor involving the epididymis. Hyperemia with color Doppler is not determined (not shown). These chronic findings are characteristic of granulomatous changes in this patient who also has mediastinal adenopathy on CT (C).

Historically it was diagnosed in patients with chronic adnexal TB infection, but granulomatous epididymitis is now sometimes considered a subacute infection in men who have received intravesical Calmette-Gue'rin for bladder cancer. Appendages may have calcifications, and inflammatory process may include surrounding testicular parenchyma. Advanced cases can lead to the development of an abscess, which may involve neighboring structures, as well as expand upward, involving the root of the scrotum (Fig. 29).

Rice. 29. Tuberculosis of the scrotum. Cold scrotal abscess (arrows) in a diagnosed case of scrotal tuberculosis. The infection crosses the border between the testicles and appendages (epi) and spreads to both departments.

POSTVAZECTOMIC EPIDIDYMITIS

Epididymitis after vasectomy can present differently with adnexal enlargement and ductal ectasia (Figure 30). In addition, spermogenic granulomas and cysts may develop after vasectomy.

Rice. thirty. Appearance of the appendage after vasectomy. Dilated tubules and heterogeneous echogenicity are shown (arrow).

SCROTOLITHES

Scrotoliths (scrotal pearls) are extratesticular free-lying bodies in the scrotal cavity, sometimes calcified (Fig. 31).

Rice. 31. Scrotoliths. Transverse sonogram shows a small echogenic scrotolith (arrow) adjacent to the testis and with normal scrotal fluid. In the absence of fluid in the scrotum, these small scrotoliths cannot be visualized and merge with the adjacent scrotal walls.

A previous episode of testicular or epididymal torsion may be the source of scrotoliths (scrotal calcifications). These calcifications may also be secondary to inflammation of the albuginea. The presence of a hydrocele facilitates the detection of these clinically insignificant bodies, which may otherwise be confluent and inconspicuous against other paratesticular structures.

High quality visualization in B- and color Doppler modes - ultrasound machine. Reliability, service, guarantee.

Granuloma is a focal proliferation of connective tissue cell structures, which is a consequence of granulomatous inflammation. By appearance they look like small nodules. They can be single or multiple. The size of the granuloma does not exceed 3 cm in diameter, the surface of the formation is flat and rough. Often, such benign neoplasms are formed when there is an infection in the body in an acute or chronic form.

The mechanism of development of a granuloma in humans is different and depends on the type of benign neoplasm, the reasons that caused its formation. For a granulomatous inflammatory process to start, two conditions must be present:

the presence in the human body of substances that give impetus to the growth of phagocytes;
persistence of the stimulus that causes cell transformation.

Sometimes a granuloma can resolve on its own, but this does not mean that if it is present, you can not consult a doctor. It is impossible to predict in advance whether the neoplasm will resolve itself.

Features of involution (reverse development):

In a few months or years, granuloma annulare can resolve on its own. It does not leave scars on the body.
With infectious lesions (syphilis), the seal resolves, leaving behind scars and scars.
In tuberculosis, granulomatous seals rarely resolve. This happens only if the patient's body is actively fighting the infection.
does not dissolve on its own.

Granuloma occurs both in adult men and women, and in children (including newborns). Different age groups the disease has the following features:

Formations that provoke autoimmune diseases often seen in young people.
IN childhood neoplasms are accompanied by a vivid clinical picture due to the imperfection of the immune system.
In women, granulomatous structures may appear during childbearing.
Syphilitic granuloma is typical for people after 40 years, because tertiary syphilis manifests itself 10-15 years after the onset of the disease.
Tuberculous granulomas in childhood can go away without treatment.

Causes of granulomas and stages of development

Doctors divide the main causes of granulomas into two groups - infectious (tuberculosis, syphilis, fungal infections), non-infectious:

Immune. They arise as a result of an autoimmune reaction of the body - there is an excessive synthesis of phagocytes (protective absorbing cells).
Infectious formations that occur with fungal infections of the skin, chromomycosis, blastomycosis, histoplasmosis and other infectious diseases.
Granulomas that appeared as a result of the penetration of a foreign body - threads of postoperative sutures, parts of insects, tattoo pigment.
Post-traumatic nodes that appear as a result of trauma.
Other factors (Crohn's disease, allergic reactions, diabetes, rheumatism).

Local cellular immunity is responsible for the appearance of a granuloma; specialists have not yet established a more accurate mechanism for the development of pathology.

Doctors allocate next steps disease development:

the initial stage is the accumulation of cells prone to phagocytosis;
the second stage is the proliferation of accumulated phagocytic cells;
the third stage is the transformation of phagocytes into epithelial cells;
the final stage is the accumulation of epithelial cells and the formation of a node.

Classification

There are many types of granulomatous neoplasms and they all differ in reasons, clinical manifestations and localization.

Eosinophilic granuloma is rare disease which often strikes skeletal system, lungs, muscles, skin, gastrointestinal tract. The reasons for the formation of this pathology are unknown. But there are several hypotheses - bone injuries, infection, allergies, helminthic invasion. Symptoms of the disease are often completely absent, and nodes are detected by chance during examination for other reasons. If the patient, against the background of the absence of signs of the disease in the blood tests, does not reveal increased content eosinophils, the diagnosis can be difficult.

Telangiectatic (pyogenic, pyococcal) granuloma. Such a formation has a small leg and resembles a polyp in appearance. The structure of the tissue is loose, the color of the neoplasm is brown and dark red, there is a tendency to bleeding. Such a granuloma is located on the finger, face, in the oral cavity.

This neoplasm is similar to Kaposi's sarcoma, so you need to urgently consult a doctor to avoid possible complications.

Annular (annular, circular) granuloma is a benign skin lesion, which is manifested by the formation of annular papules. The most common form of this disease is a localized tumor - these are small smooth pink nodules that form on the hands and feet.

Stuart's median granuloma (gangrenescent). Characterized by an aggressive course. Accompanied by the following symptoms:

nosebleeds;
nasal discharge;
difficult nasal breathing;
swelling of the nose;
the spread of the ulcerative process to other tissues of the face, throat.

Migratory granuloma (subcutaneous) grows rapidly, accompanied by the appearance of erosions and ulcers on the surface. This type neoplasms are prone to malignancy (degeneration into a cancerous tumor), so it is imperative to consult a doctor to prescribe effective treatment.

Cholesterol - a rare inflammation of the temporal bone, which is provoked by trauma, inflammation of the middle ear, as well as the existing cholesteatoma.

Lymphatic neoplasm is accompanied by fever, cough, weight loss, itching at the site of injury, weakness, soreness of enlarged lymph nodes. Over time, the disease can lead to damage to the liver, lungs, bone marrow, nervous system.

A vascular granuloma is a series of skin growths that contain blood vessels.

An epithelioid tumor is not an independent pathology, but a type of formation in which epithelioid cell structures predominate.

Purulent granuloma of the skin. This group includes all formations that have signs of an inflammatory process. It can be rheumatoid and infectious tumors.

Ligature (postoperative) granuloma is a seal in the area postoperative suture(both inside and outside). It occurs due to the ingress of the smallest foreign particles on the tissues after surgical intervention. In the process of regeneration, this area is covered with connective tissue and a pea-sized knot is formed. Often such a seal resolves on its own.

Sarcoid granulomatous mass occurs in the lymph nodes and internal organs with sarcoidosis.

A syphilitic tumor occurs as a complication of syphilis if the disease is not treated for a long time.

Tuberculous (caseous) granuloma is a morphological inflammatory element, which is provoked by the penetration of microbacteria into the respiratory organs. In this case, the cellular structure of the organ, their composition and vital activity are disturbed.

Giant cell granuloma is located in bone tissue. This benign neoplasm, which is not prone to growth.

Localization features

The inflammatory focus in patients is located superficially or deeply. By location, granulomatous formations are classified as follows:

nodal structures of the soft tissues of the body (skin, navel, lymph nodes);
inguinal granuloma (vagina, penis). This form of the disease is also called venereal (or donovanosis);
oral mucosa (tongue, vocal cords, larynx);
subcutaneous;
muscular;
vessel walls;
seals of the bones of the skull, jaw.

The most common localization of granulomas:

head and face (eyelids, cheeks, ears, face, lips, nose, temples);
sinuses;
larynx (this form of the disease is also called contact);
limbs (hands, nails, fingers, legs, feet);
eyes;
intestines;
lungs;
liver;
brain;
kidneys;
uterus.

Let us consider in more detail the most common places for the localization of such seals.

Nail granuloma

Pyogenic granuloma is a pathology of the nail plate. It appears on any part of the nail in the presence of even a small penetrating wound. The initial stage of the nail granuloma is a small red nodule, which very quickly forms an epithelial collar. If the formation is located in the region of the posterior nail fold, then the matrix (a section of the epithelium of the nail bed under the root part of the nail plate, due to cell division of which the nail grows) is affected and a longitudinal cavity is formed. Sometimes a granuloma of the nail appears with prolonged friction or after a perforating injury. Also, similar lesions can be observed during therapy with cyclosporine, retinoids, indinavir.

Breast granuloma

to granular diseases mammary glands relate:

lobulitis or granulomatous mastitis in chronic forms;
knots that occur during penetration foreign bodies(wax or silicone);
mycoses;
giant cell arteritis;
nodular polyarteritis;
cysticercosis.

Symptoms of a granuloma in the chest in girls may not appear for a long time, but sooner or later a hematoma appears on the skin. At this moment, the woman begins to feel pain and discomfort at the site of the lesion, and when probing the mammary gland, a tuberous seal is palpated. In this case, there is a deformation of the breast. As the disease progresses, the organ may lose sensitivity.

Breast lipogranuloma does not transform into oncology.

Diagnostics

It is easy to detect external skin granulomas, but it is difficult to detect neoplasms on internal organs, in the thickness of soft tissues or bones. For this, doctors use ultrasound, CT and MRI, x-rays, biopsies.

Since granulomatous formations can be found in any organ and in any tissue of the body, they are diagnosed by doctors of different specialties:

radiologist - during a preventive examination;
surgeon - during surgery or in preparation for surgery;
rheumatologist;
dermatologist;
dentist.

The same doctors can also treat the disease (with the exception of the radiologist), and, if necessary, involve specialists from other areas.

Methods of treatment and removal

Treatment of granuloma is carried out using the following physiotherapeutic and surgical methods:

phonophoresis;
dermabrasion (mechanical clean, designed to eliminate superficial and deep skin problems);
PUVA therapy;
magnetotherapy;
cryotherapy (impact on neoplasm liquid nitrogen, due to which the freezing of the affected tissue occurs);
laser therapy (removal of granulomas with a laser).

Drug treatment of granuloma is the appointment of corticosteroids. Your doctor may also prescribe:

Ointment Dermovate;
Hydroxychloroquine;
Dapsone;
Niacinamide;
Isotretinoin;
drugs that improve blood microcirculation;
vitamins.

IN without fail measures should be taken to treat the underlying pathology, if it is possible to accurately diagnose it.

Not all granulomatous formations require immediate removal surgery. It is useless to remove some neoplasms at all, especially if they are caused by infectious or autoimmune processes. Superficial nodes are removed with a scalpel under local anesthesia. The method of surgical intervention is chosen by the attending physician based on the signs of the disease, diagnostic data and patient complaints.

Folk remedies and methods of treating granulomas must be agreed with the doctor without fail. This is due to the fact that some plants contain substances that can cause active growth of the node and its malignancy (degeneration into a cancerous tumor).

The most common folk remedies:

Mix tincture (30%) of celandine with pharmacy glycerin. Make compresses at night.
In a ratio of 1: 5, take the roots of elecampane and dry rose hips. Pour boiling water, insist and take as tea.
Take a tablespoon of lemon juice and honey, add 200 ml of radish and carrot juice. Take a tablespoon before meals.

Only a specialist should treat granulomas. Self-treatment and removal of nodes can lead to consequences such as infection, profuse bleeding, sepsis, sclerosis and tissue necrosis.

An inflammatory granuloma is a tumor built according to the type of granulation tissue. Mostly geldings are affected, but males of other species can also be affected.
Granulomas of the spermatic cord can be nonspecific and specific, or infectious, observed in the complication of actinomycosis or botryomycosis.

Etiology. The granuloma of the spermatic cord may be the result of irritation with a poor-quality coarse ligature, the application of a ligature or forceps in the area of the vascular cone, cauterization of the stump of the spermatic cord alcohol solution iodine or other irritants chemicals, incomplete removal of appendages, hit on the stump foreign objects, damage to the stump of the cord by actinomycosis or botryomycosis.

Pathogenesis. Nonspecific granulomas develop as a result of irritation of the tissues of the cord. The body responds to any prolonged irritation with an inflammatory reaction and increased growth of granulation tissue. In cases where the irritant is not fixed in the tissues, it is, as a rule, excreted by exudation into external environment and recovery is coming. If the irritant is fixed in the tissues, for example, a poor-quality ligature in horses, then the inflammation continues and is accompanied by increased growth of granulation tissue and the formation of a granuloma, which can reach large sizes. In the future, fibrinous degeneration of the granuloma occurs and it itself becomes an irritant and supports the course of the reactive process in the form of purulent or fibrinous inflammation.

There may be a complication of the spermatic cord with actinomycosis or botryomycosis. Fungal granulomas grow slowly and can be of various sizes.

Clinical signs. Specific granulomas are much less common; botryomycosis, as a rule, in horses, actinomycosis in artiodactyls. More often, nonspecific granulomas of the spermatic cord are recorded in males of all species. They are mushroom-shaped or spherical in shape, of different sizes. In some cases, the granuloma grows, pulls the spermatic cord and falls out of the wound of the scrotum. Its surface is dark red, covered with exudate, crusts and fibrin. With a complication of infection, body temperature may increase.

With actinomycosis granuloma, abscesses and purulent fistulas form on the surface. Purulent exudate thick white color. Microscopy establishes botryomycotic drusen. Granulomas are tuberous, fused with surrounding tissues; there may also be abscesses and purulent fistulas on the surface. In either case, the process can take years.

Diagnosis. The disease is diagnosed by clinical signs. Exclude actinomycosis or botryomycosis granuloma or tumor by biopsy, microscopic or bacteriological examination.

Forecast. With nonspecific granulomas, the prognosis is favorable, with specific ones in fresh cases - favorable, in advanced cases - cautious or unfavorable.

Treatment. All granulomas of the spermatic cord are removed surgically by the type of open castration. If the granulomatous process spreads to the surrounding tissues, these tissues must be removed as far as possible. Prescribe antibiotic therapy and monitor the general condition of the body.

POST-CASTRATION COMPLICATIONS.

Complications after castration are conditionally divided into two groups: early and late.

Early complications are observed immediately after castration. These include: bleeding, prolapse of the omentum, intestines, bladder, common vaginal membrane and stump of the spermatic cord.

Late complications are detected a day or more after castration. These include: inflammation of the common vaginal membrane, inflammation of the stump of the spermatic cord, granulomas, abscesses, gangrene, peritonitis and sepsis.

Complications of the first group, as a rule, are not widespread, complications of the second group, especially in boars and rams, can be massive.

BLEEDING (HAEMATORRHOEA)

Bleeding can be from the artery and vein of the scrotum, the artery and vein of the spermatic cord, the artery of the testes, the artery of the vas deferens. The most dangerous bleeding from the vessels of the spermatic cord.

Etiology. The causes of bleeding can be: insufficient crushing of the tissues of the spermatic cord with castration forceps; sharp clamping of the spermatic cord with castration forceps, which causes not crushing, but a blunt intersection; technical malfunction of the tongs, which does not allow to clamp the tongs completely; weak clamping of the spermatic cord with a ligature, as a result of which the ligature may slip off; the so-called castration on the “separation” of the spermatic cord without control of the place of separation, as a result of which the spermatic artery sometimes comes off directly from the aorta; flabbiness of the tissues of the spermatic cord; vascular atherosclerosis in old males (boars and stallions); reduced blood clotting; sclerosis of the skin of the scrotum and varicose veins veins; unsanitary keeping of animals after castration.

Clinical signs. Bleeding can be primary or secondary. The primary manifests itself during the operation itself or several hours after its completion, and the secondary - several hours or even days after castration. Distinguish between external and internal bleeding.

From the arteries of the spermatic cord, blood flows most often in a small stream or a strong stream. The pressure of bleeding depends on the damage to the vessel. External bleeding and its type are determined when establishing and carefully examining the place of bleeding. A large blood loss is determined by the signs of acute anemia: pallor of the mucous membranes, increased respiration and pulse (weak filling), trembling of the animal, unsteady gait. When examining blood, a sharp decrease in the content of hemoglobin and erythrocytes is noted.

Internal bleeding is determined by increasing signs of acute anemia. The vessels of the scrotum bleed in drops, but for a long time, the blood is dark, venous.

Diagnosis. External bleeding is diagnosed by local signs, internal bleeding - by increasing signs of acute anemia, the content of red blood cells and hemoglobin is additionally determined. A sharp decline the latter indicates a significant loss of blood.

Treatment. The animal is given rest, plenty of cool water is given. Bleeding is stopped depending on the place of leakage: capillary bleeding from the scrotum - with tampons dipped in adrenaline; from the vessels of the spermatic cord - by applying a ligature to the extracted spermatic cord. Calcium chloride is administered intravenously. With a significant loss of blood, transfusion of blood substitutes is performed. To avoid complications of surgical infection, vikasol, antibiotics or sulfa drugs are prescribed.

EVENTRATION (LOSS) OF THE OIL (EVENTRATIO OMENTI)

Omental prolapse is most common in stallions with open castration. This complication can occur at any time during the operation or immediately after it. There are known cases of omentum falling out a few hours and days after castration. Omentum prolapse was observed in a stallion on the 11th day after the operation.

Etiology. Omental prolapse usually occurs with dilated inner rings of the vaginal (inguinal) canal. Perhaps it is with a strong tension of the abdominal press during the operation, especially if it is done without anesthesia, if the starvation diet before the operation is not observed or the fasting diet is too long.

Clinical signs. The part of the omentum that has fallen out can reach a considerable size and hangs down to the hocks. The dropped part of the omentum quickly becomes contaminated, infected and infringed in the vaginal canal. There are congestive hyperemia and swelling of the omentum. If the omentum fell into the cavity of the common vaginal membrane before castration, then the scrotum is enlarged in volume and testy to the touch.

When the omentum falls out, the animal does not show any pain reaction and stands calmly, although the part of the omentum that has fallen out can almost touch the ground. Temperature, pulse, respiration do not change.

Diagnosis. The diagnosis is based on clinical signs. It is necessary to differentiate the disease from prolapse of the intestines and bladder.

Forecast. With small deposits, the prognosis is favorable, with large ones with the presence of necrosis, it is cautious.

Treatment. If the omentum has fallen out after the operation, the animal is fixed in a standing position, a second fall should be avoided and resorted to only in extreme cases. Do surgical treatment of the fallen part of the omentum, isolate it with a sterile gauze napkin or towel. Then, in the absence of changes in the omentum, it is inserted into the vaginal cavity. If there is necrosis, then a ligature is applied to the healthy part, the underlying part of the omentum is cut off with scissors 0.5-2 cm below the ligature. Antibiotics are used to prevent the development of a surgical infection.

Intestinal prolapse is one of the most dangerous post-castration complications. Most often occurs in rabbits, boars and stallions.

Etiology. The causes of the disease are the same as with the prolapse of the omentum: improper fixation, i.e., strong compression of the abdominal press; public method castration with a wide internal inguinal ring; rupture of the muscles that form the inguinal canal.

Pathogenesis. The prolapsed intestine quickly dries up in the air and becomes contaminated. In addition, it is infringed in the vaginal canal. At the same time, the outflow of blood, the nutrition of the intestine are disturbed. Its color changes. Brown spots appear, which indicates necrosis of the intestinal wall. In addition, swelling and fissures of the intestine are observed.

Clinical signs. Loops of the small intestine usually fall out of one castration wound. Bilateral prolapse is a rare case. Most often, the intestine falls out during castration, less often after it. A case of intestinal prolapse in a stallion on the 5th day after castration is described.

In stallions, the intestinal loop hangs down to the hocks and even to the ground. Boars often have eventration of a large part of the intestine in the form of short loops that form a whole ball.

In the external environment, the intestine is irritated, and the animal reflexively reacts to it as to a foreign body. As a result, muscles abdominals are sharply reduced. Stallions get colic. If more than 6 hours pass after the fallout, then the stallions may develop peritonitis, body temperature rises, pulse and respiration become more frequent. The animal is oppressed.

Diagnosis. The disease is diagnosed on the basis of a clinical examination. Differentiate from prolapse of the bladder, omentum.

Treatment. Protect the prolapsed part of the intestine from drying out and contamination. To do this, use a sterile sheet and napkins, watered with warm saline. The operation is performed under anesthesia. The animal is fixed in a supine position. After examination and treatment, the intestines are set. To do this, straighten the common vaginal membrane and fix it by the edges of the wound. A finger is inserted between the intestines and the canal wall and the degree of intestinal infringement is determined. If there is no infringement, the prolapsed part of the intestine is set with the index finger, starting from the part of the intestine that is in contact with the wall of the vaginal canal. Gradually, slowly, they push the intestine in small parts. In the presence of gases, a puncture is made with a thin injection needle at an angle of 45 °. When the intestine is infringed in the vaginal canal, under the control of the index finger, the outer ring is cut by 2-4 cm with a bell-shaped scalpel. The wall of the canal should not be cut forward and inward, so as not to damage the posterior hypogastric artery. After dissection, the intestines are adjusted, and then 2-4 knotted sutures are applied. If the intestinal wall is damaged, sutures are applied, necrotic sections of the intestine are excised. After the operation, the animal is prescribed rest, good dietary feeding, water is given in small portions. To reduce thirst, an isotonic sodium chloride solution and a 30% glucose solution are administered intravenously to the animal - 300-400 ml each. PROLAPSUS TUNICAE VAGINALIS COMMUNIS

The prolapse of the common vaginal membrane is more often observed in stallions and, as a rule, after inept castration in camels:

Etiology. The causes of the disease can be a large detachment of the common vaginal membrane, adhesions of the testis own membrane with the common vaginal membrane, sclerotic changes in the membrane itself in old boars.

Pathogenesis. The fallen part of the common vaginal membrane becomes contaminated, infected, and inflammation of the common vaginal membrane develops.

Clinical signs. After castration of the animal, especially when the animal is standing, a common vaginal membrane hangs from the castration wound on one side or on both sides in the form of rollers. The edges of the skin are swollen. The general condition of the animal does not change. If purulent inflammation develops, the general condition also changes: body temperature rises, pulse and respiration become more frequent.

Diagnosis. They put it when examining a wound.

Forecast. In the initial stage of the disease, the prognosis is favorable, in advanced cases - cautious, since complications are possible.

Treatment. Operational. The fallen out shell is excised before its exfoliation, the blood is stopped and antiseptics are used to avoid complications with a purulent infection.

PROLAPSUS FUNICULI SPERMATIEI STUNT

The prolapse of the stump of the spermatic cord is more often observed in stallions, camels, less often in animals of other species.

Etiology. Stump prolapse is possible with excessive tension of the spermatic cord, too low or high incisions of the scrotum, tears of the muscles of the testis lifters, separation of the testes in the area of the vascular cone.

Pathogenesis. The fallen part of the spermatic cord becomes contaminated and exposed to physical environmental factors. There is inflammation of the spermatic cord, which can go to the common vaginal membrane and peritoneum. Often, a granuloma develops as a result of irritation.

Clinical signs. Depending on the cause, the fallout can occur immediately after surgery or after 2-3 days. The hanging part of the stump is visible from the castration wound. In advanced cases, inflammation or complications with various fungi, such as botryomycoma, are possible.

Diagnosis. They put it when examining the wound: the hanging spermatic cord is clearly visible.

Treatment. In all cases, observing all the rules of asepsis, cut off the fallen part of the stump of the spermatic cord within healthy tissue and apply a ligature (in horses - only catgut, otherwise there may be complications).

PROLAPSUS VESICAE URINARIAE

The disease can occur in animals of all species, but is more common in stallions and boars.

Etiology. It usually happens with a wide internal inguinal ring and canal, rupture of the internal inguinal ring, hernia, rickets.

Clinical signs. The bladder exits into the vaginal or inguinal canal. When prolapsed into the vaginal canal, a swelling is found along the latter. When pressing on this swelling, urination occurs, and its size decreases somewhat. When examining a castration wound, a bladder is found in the form of a ball covered with fibrin films.

When the bladder prolapses into the inguinal canal, a swelling is found next to the scrotum in the area of the external opening of the canal. It slowly increases as the bladder fills. When pressing on the swelling, urine is released. In case of rupture of the bladder, peritonitis develops after a while. In this case, there is no swelling, the tissues are saturated with urine.

Diagnosis. They put it in the study of a castration wound on clinical grounds.

Forecast. In recent cases, if there is no rupture of the bladder, the prognosis is favorable, in other cases - unfavorable.

Treatment. After clarifying the diagnosis, surgical treatment of the wound and the bladder is performed, freeing from urine. By clicking on it, set in abdominal cavity. The vaginal canal is closed with a vaginal membrane, as in the closed castration method.

In advanced cases, an incision is made over the inguinal ring, as in hernia repair. With a strong filling of the bladder, urine is removed by pressing on it, or by puncture, then the bladder is set into the abdominal cavity. The ring is closed, as in hernia repair. When the bladder is ruptured, intestinal sutures are placed. Monitor the general condition of the animal.

Post-castration edema (OEDEMA POSTCASTRATIONEM)

After castration, an inflammatory edema develops as a reaction of the body to injury. This most frequent complication is sometimes massive.

Etiology. Inflammatory edema can be in violation of asepsis and antisepsis; castration of dirty, unprepared animals; post-castration infection of wounds, when rooms for castrated animals are dirty; with careless castration, when a lot of blood remains in the wound; with small incisions, stratification of tissues. Contribute to the development of edema castration of sick animals, allergic disorders, loose constitution, non-compliance with post-castration care for animals, lack of walks, hypoavitaminosis, prolonged castration.

Pathogenesis. In stallions, the initial reaction is always manifested by the development of serous or serous-fibrinous inflammation, which turns into serous-purulent after 3-4 days. The inflammatory process develops where more dead tissue, clotted blood, and then goes to other areas, capturing the loose tissue of the inguinal canal, and phlegmon develops. In horses, as a rule, gram-positive monoinfection, rarely associations.

In male artiodactyls, the complication of wounds mainly occurs with gram-positive and gram-negative polyinfection, there may be a combination of aerobes with anaerobes. The presence of blood and dead tissue in the wound contributes to the development of infection. The initial reaction in artiodactyls is manifested by fibrinous inflammation, which turns into purulent after 8-20 days. In connection with the loss of fibrin and the closure of the wound, conditions are created for the development of anaerobic phlegmon or abscess. In severe cases, gangrene of the scrotum or sepsis is possible.

Clinical signs. As a rule, inflammatory edema after castration is a normal reaction of the body. If the scrotum increases by 1.5-2 times or more, inflammatory edema spreads to the prepuce and even to the stomach, high neutrophilic leukocytosis appears, this indicates a complication of infection. If the body temperature rises by 1 - 1.5 "C, when providing medical assistance, after 10-12 days, all indicators of the body return to normal. At a temperature of 40 "C and above, increased heart rate and respiration, depression, refusal to feed, phlegmon develops. A serous or serous-fibrinous exudate is first released from the wound, then purulent.

In boars, four forms of complications are distinguished, accompanied by edema against the background of major diseases: phlegmon, vaginitis, vaginalito-phoniculitis and peritonitis. Here are all the clinical signs inherent in these diseases.

In bulls and sheep, inflammatory edema develops against the background of anaerobic phlegmon. If you do not provide assistance, the animals die from anaerobic sepsis.

Diagnosis. The disease is diagnosed on the basis of clinical signs; the type of microorganisms is determined by bacteriological research. However, inflammatory edema should be differentiated from congestive edema. Congestive edema is always cold, painless, when pressed with a finger, the fossa is slowly filled. Inflammatory edema has all the signs of inflammation.

Forecast. In the initial stages with active complex treatment, the prognosis is favorable, in advanced cases - cautious or unfavorable, peritonitis and sepsis may develop.

Treatment. In inflammatory edema, treatment should be

urgent and complex. With general treatment, a course of antibiotics is prescribed. In these cases, subtitration is done and the most sensitive antibiotic to the microflora under study is established.

Without titration, horses are most indicated for antibiotics of the penicillin series, better prolonged bicillin-3 or bicillin-5; for boars, bulls, rams - a combination of penicillin and streptomycin equally. Doses of antibiotics - 15-20 thousand units per 1 kg of animal weight. Intravenously prescribed glucose, calcium chloride, camphor serum according to Kadykov's prescription. In order to desensitize the body, novocaine is administered intravenously. At high temperatures, intravenous injections should be done very slowly, preferably by drip. Local treatment is carried out, surgical treatment of the wound, purulent exudate lingering between adhesions is removed. When the body temperature drops to normal, apply heat, light massage, dosed wiring, starting from 10 minutes and gradually increasing to 30-40 minutes 2 times a day.

INFLAMMATORY OF THE COMMON VAGINA (VAGINALITIS)

The disease is more common in stallions, boars and rams.

Etiology. The reasons may be: detachment of the common vaginal membrane during surgery; large infiltration with novocaine solution during anesthesia; too low and high cuts; accumulation of clotted blood; contamination of the cavity of the common vaginal membrane; the transition of the inflammatory process to the common vaginal membrane along the continuation from the stump of the spermatic cord; bruises of the testes with the formation of connective tissue adhesions; burns of the common vaginal membrane with an alcohol solution of iodine during castration.

Pathogenesis. After removal of the testicles, the common vaginal membrane is often pulled upward due to a strong contraction of the external cremaster. If the incisions were of insufficient length, then there is a adhesion of the sheets of the common vaginal membrane pulled upward due to serous-fibrinous or fibrinous inflammation along the line of its incision. This leads to the formation of a cavity between the sheets, separated from the cavity of the wound of the scrotum. The so-called "hourglass" is formed (Fig. 36). Exudate accumulates in this cavity, which compresses the tissues, causing a strong pain reaction. With aseptic inflammation, the exudate is resorbed, but if the process is complicated by microflora, then purulent inflammation develops. The absorption of decay products from a closed purulent cavity is accompanied by an acute reaction of the body.

In boars, the "hourglass" is formed at small, low

Fascia sub-dartoici

T. vagina/is communis

stump seed

~ foot canateak

inflame, exudate

incisions of the scrotum. At the site of the incision, a gray scab is formed, the shell itself sprouts with connective tissue and significantly increases in volume.

Rice. 36. Formation of a wound in the form of an "hourglass" (B. M. Olivkov)

In bulls, fibrinous inflammation of the membrane is also observed, only with a more pronounced connective tissue reaction.

Clinical signs. In stallions in the first 5 days and later, after castration, when the wound is already granulating, diffuse edema may develop rapidly. In this case, the body temperature rises to 39.5-40 "C, the general condition of the animal worsens sharply, neutrophilic leukocytosis is observed. Locally, unilateral or bilateral hot, painful swelling of the scrotum is noted. With the formation of an "hourglass", the exudate discharge is insignificant, on palpation in the upper part of the scrotum fluctuation is detected. hourglass» Exudate is immediately released in large quantities. He's liquid yellow color, with fibrin. After removing the exudate, the overall reaction of the body immediately improves.

In boars, the disease is also severe. The swelling is painful, has a spherical shape. From the castration wound, exudate of a putrid odor is released in a small amount.

Forecast. In recent cases, the prognosis is favorable, in advanced cases - cautious or unfavorable.

Treatment. It is necessary to make mechanical antiseptics and toilet wounds with a 3% hydrogen peroxide solution. If an hourglass has formed, adhesions are eliminated and exudate and dead tissue are removed. At elevated temperatures, antibiotic therapy is prescribed.

Inflammation of the stump of the spermatic cord (FUNICULITIS)

Inflammation of the spermatic cord is more common in stallions, boars and sheep.

Etiology. The main causes of funiculitis: infection of the stump of the spermatic cord during surgery, when the rules of asepsis and antisepsis are violated; prolapse of the stump from the wound;

a large area of crushing of the stump; the imposition of a ligature or forceps in the area of the vascular cone; the imposition of a rough ligature, difficult to encapsulate or resorb; the formation of hematomas in the vascular cord; leaving significant curls at the end of the stump when unscrewing the spermatic cord; complication of botryomycosis and actinomycosis fungi. Reduced body resistance to infections, traumatic shock, etc. predispose to inflammation of the spermatic cord.

Pathogenesis. After the removal of the testicles, aseptic inflammation develops as a reaction to mechanical trauma. If the inflammatory process is not complicated by a surgical infection, this is where it ends. When the stump of the spermatic cord becomes infected, the body's reaction to the infection develops. With timely treatment, a demarcation shaft may form and the dead stump will move away with exudate. However, with a weak demarcation shaft, the infection spreads along the continuation, forming blood clots, necrosis, abscesses.

In severe cases, the pathological process spreads along the cord and the vaginal canal, and peritonitis, purulent fistulas with the release of purulent exudate are possible. The process may end in sepsis.

In horses, the inflammatory process can be complicated by botryomycosis, and in artiodactyls by actinomycosis; possible granuloma of the spermatic cord.

Clinical signs. The first symptoms of the disease are pain, pronounced on palpation, and an increase in the size of the spermatic cord. The swelling can be unilateral or bilateral. Acute inflammation appears on the 3-5th day after castration. The general condition of the animal changes: it is depressed, completely or partially refuses to feed; body temperature rises, neutrophilic leukocytosis increases. The movement of the animal is difficult with abduction of the pelvic limb. In horses, after 3-4 days, abscesses form along the spermatic cord, then fistulas and ulcers, the cord becomes dense and immobile. Peritonitis may develop.

Diagnosis. The disease is diagnosed by clinical signs.

Forecast. In recent cases, favorable, in neglected cases, there may be various complications: peritonitis, sepsis, metastatic pneumonia.

Treatment. Carry out mechanical and chemical antiseptics. In fresh cases, a stump of the spermatic cord is found, it is tied up in a healthy part and the inflamed part is cut off. In advanced chronic cases, all dead tissue and the stump of the spermatic cord are removed, or incisions are made in the groin area and all dead tissue is removed. The cavities are washed with a 3% hydrogen peroxide solution, Vishnevsky's emulsion is used, etc. General antibiotic therapy and symptomatic treatment are prescribed.

GRANULOMA FUNICULI SPERMATICIS

An inflammatory granuloma is a tumor built according to the type of granulation tissue. Mostly geldings are affected, but males of other species can also be affected.

Granulomas of the spermatic cord can be nonspecific and specific, or infectious, observed in the complication of actinomycosis or botryomycosis.

Etiology. A granuloma of the spermatic cord can be the result of irritation with a poor-quality coarse ligature, the application of a ligature or forceps in the area of the vascular cone, cauterization of the stump of the spermatic cord with an alcoholic solution of iodine or other irritating chemicals, incomplete removal of appendages, foreign objects on the stump, lesions of the stump of the funiculus with actinomycosis or botryomycosis.

Pathogenesis. Nonspecific granulomas develop as a result of irritation of the tissues of the cord. The body responds to any prolonged irritation with an inflammatory reaction and increased growth of granulation tissue. In cases where the irritant is not fixed in the tissues, it is usually exuded into the external environment by exudation, and recovery occurs. If the irritant is fixed in the tissues, for example, a poor-quality ligature in horses, then the inflammation continues and is accompanied by increased growth of granulation tissue and the formation of a granuloma, which can reach large sizes. In the future, fibrinous degeneration of the granuloma occurs and it itself becomes an irritant and supports the course of the reactive process in the form of purulent or fibrinous inflammation.

There may be a complication of the spermatic cord with actinomycosis or botryomycosis. Fungal granulomas grow slowly and can be of various sizes.

With actinomycosis granuloma, abscesses and purulent fistulas form on the surface. Purulent exudate is thick, white. Microscopy establishes botryomycotic drusen. Granulomas are tuberous, fused with surrounding tissues; there may also be abscesses and purulent fistulas on the surface. In either case, the process can take years.

Diagnosis. The disease is diagnosed by clinical signs. Exclude actinomycosis or botryomycosis granuloma or tumor by biopsy, microscopic or bacteriological examination.