Complications of hydrocele.— The following are the principal : I. Simple hydrocele, com bined with encysted hydrocele of the testicle. 2. Simple hydrocele, combined with encysted hydrocele of the spermatic cord. 3. Simple hydrocele, combined with diffused hydrocele of the spermatic cord. 4. Oscheo-hydrocele, including both simple hydrocele and encysted hydrocele, combined respectively with inguinal hernia.
I. The first is not an uncommon compli cation. In the dissection of these parts, I have often found the tunica vaginalis distended with three or four drachms, and even an ounce or two of serum, two or more small distinct cysts being at the same time connected with the upper part of the epididymis ; and I have twice met with this complication in both sides in the same individual. The small adventi. tious cysts appear to be the original disease, the irritation produced by them being in all probability the cause of the increased quan tity of fluid in the tunica vaginalis.
2. The second complication is somewhat rare. In the pathological collection at the London Hospital, there are two specimens of a collection of fluid in the tunica vaginalis as sociated with an encysted hydrocele of the spermatic cord. In one of them the tunica vaginalis is unobliterated for about two inches along the spermatic cord, and the encysted hydrocele is immediately above it. In the other preparation it is apparent that both sacs have been the seat of inflammation, false mem branes being contained within them. This complication sometimes occurs in infants.
3. Simple hydrocele associated with dif fused hydrocele of the cord is also rare. A good delineation of this complication is given in Scarpa's work.
4. Scrotal hernia may be combined with hydrocele. A voluminous hydrocele, if un supported, appears to be highly favourable to the occurrence of hernia and the extension of the sac, by dragging down the peritoneum. Oscheo-hydrocele is not an uncommon complication. In most of the cases which I have met with, the hydrocele was placed be low and free of the rupture, and in a few only in front of it. I have never found the hernial sac covering the fore part of a hydrocele. The ordinary relations of hydrocele and scro tal hernia may he seen in the accompanying woodcut. In figure 638., the sac of an in guinal hernia is represented at some little distance above a small hydrocele. Dupuytren states that, when a hydrocele is placed in front of a hernia, a part of the omentum or intestine sometimes descends into a cyst, which projects into the hydrocele, and is formed of the hernial sac and serous fold of the tunic of the testicle.* This complica
tion is of the nature of the hernia infantilis, described by Mr. Key, and called by Sir A.
Cooper encysted hernia of the tunica vagivalis.
Heematocele.— This is a term applied to the swelling occasioned by effusion of blood in the sac of the tunicavaginalis, or in a cyst connected with the testicle ; it is also applied to tumours produced by extravasation, either in the sub stance of the spermatic cord, or in the sac of an encysted hydrocele of this part. Heerna tocele of the testicle, in which blood is effused into the tunica vaginalis, is by far the most common form of this affection. The extra vasation may take place in a healthy state of the parts, or it may succeed, or be combined with hydrocele. The first variety occurs from the accidental rupture of some blood-vessel, probably one of the vessels ramifying between the tunica albuginea and tunica vaginalis testis, owing either to a blow or a violent straining effort. The second variety, in which the extravasation takes place in combination with hydrocele, is of more frequent occur rence than the first. It may also be produced by a blow, or by the wound of some vessel, in the operation of tapping. A blow occa sions a slight rupture of the tunica vaginalis, and of some of the enlarged vessels ramifying outside it, and the blood which escapes passes into the sac and mixes with the fluid of the hydrocele, producing a sudden increase in the size of the tumour. The liability to this ac cidental effusion of blood is increased by a diseased condition of the arteries, such as is commonly met with in old people. The quan tity of blood effused under these circum stances varies considerably. It may be merely sufficient to impart a red tinge to the serum. In general, however, it is greater in amount, and coagula are formed, which remain undis solved in the fluid. A hmmatocele may be produced in the operation of tapping a hydro cele, in two ways. It may be occasioned by the accidental wound of some vessel rami fying over the tunica vaginals, which, instead of bleeding externally, or into the areolar tissue of the scrotum, pours its blood into the sac of the hydrocele ; or it may be caused by the trocar or lancet penetrating too far, and wounding the testicle or spermatic artery.