Ayurveda Medicinal Management of Encysted hydrocele in a Child (A Case Study)

Encysted hydrocele is a condition usually affecting children. A case of encysted hydrocele of right cord in 3 year old male child was reported. The diagnosis was made Encysted hydrocele on the basis of signs & symptoms and Ultra sonography. . The patient was suggested for the surgery, by the eminent pediatricians. Surgery was not preferred by parents of the patient. The patient has shown interest to follow, Ayurveda treatment, willingly. An Ayurveda medicinal management was done and found effective in the case of Encysted Hydrocele with abnormally enlarged scrotum. Patient was advised to follow the Ayurveda management for 1 month. Follow up report has shown encourageous result. The size of right testicle was significantly reduced and returned to almost normal size.


Introduction
Hydrocele is a scrotal collection of clear fluid ("hydro"water) in a thin walled sac ("cele" -swelling) that also contains the testicle. An encysted hydrocele or a non-communicating type of inguinal hydrocele, is a loculated fluid collection along the spermatic cord, separated from and located above the testicle and the epididymis, as a result of aberrant closure of the processus vaginalis. This is idiopathic in most cases but in some cases it may be emerged secondary to testicular torsion, tumour or trauma, and in infections, as can be seen in , orchitis, epididymitis, tuberculosis or filariasis. [1] Encysted hydrocele of the cord remains asymptomatic or is detected incidentally during evaluation of other disease. [2] Rarely hydrocele of pancreatic origin has been reported to occur. [3] This article is a detailed report of a recent Ayurvedic medicinal management of Encysted hydrocele.

Case History
The parents of 3 year old boy found swelling in the child's right groin. He had no history of vomiting or constipation. The patient was born by normal vaginal delivery. There was no important past medical, surgical, or family history. On examination, the patient's abdomen was soft, non-tender, and non-distended, and there were normal active bowel sounds. A soft swelling was palpated in the right inguinal canal. The testes were descended bilaterally and were non-tender to palpation. College, Jodhpur, on 1 st June 2013, for obtaining final opinion. He has advised to follow the USG of whole abdomen and Scrotum (Fig. -2). It was re-confirmed. Parents have consulted with the authors on 6 th June 2013, for opting an Ayurveda medicinal management to avoid surgery.  The case was taken up and reconfirmation of diagnosis was done through repeated USG. (Fig-3)The same diagnosis was re-confirmed. Treatment / Management were commenced on 6 th June 2013. A do & don't guidelines was issued to parents. Parents were advised to follow the management, strictly. Examination of patient shown that the size and swelling of Rt testicle was reduced significantly and returned to normal size. Same treatment was repeated. Patient was brought again on 14 th July 2013. It has been observed that markedly improvement in the size and enlargement of the (Rt )Right testicle. Hence, it is advised to go for Ultra Sono Graphy (USG). (Fig-4)

Results
On 14 th July 2013 the patient was advised for USG of abdomen and scrotum for the confirmation of reduction in

Discussion
During fetal development in the male, the testicle descends through the inguinal canal into the scrotum pulling along a sac-like extension of the peritoneum. By the first year of life, this extension condenses into a fibrous cord-the processus vaginalis, preventing the communication of peritoneal cavity with the scrotum. A thin membrane of this original extension remains surrounding the testicle which is named the tunica vaginalis. If this extension of peritoneum fails to close, based on the size of the defect, fluid or abdominal contents may enter the inguinal canal, resulting in a hydrocele or hernia. Congenital hernia or hydrocele, though more common in males, is rarely seen in females. In the female fetal development, round ligament of the uterus descends into the inguinal canal to the labium major. [4] The main pathological conditions manifesting as masses in the groin fall into five major groups: congenital abnormalities, non-congenital hernias, vascular conditions, infectious or inflammatory processes, and neoplasms. [5] Inflammatory swellings of the groin are common, and the changes are often attributed to infection and are often inflammatory swellings secondary to groin hernia. [6]However, painful spermatic encysted hydrocele presenting as a groin swelling is rare. Diagnosis is clinicaly essential but where doubt exists, scrotal ultrasound can be used to differentiate it from other scrotal lesions. Diagnosis can also be confirmed by computed tomography scan or intraoperatively. Spermatic cord hydrocele is effectively diagnosed by ultrasonography based on its specific location and shape. Ultrasonography is useful to exclude hernia, enlargement of the lymph node, or other solid masses. [7]

Conclusion
Encysted hydrocele in a child is common, now days. First choice of treatment is the surgery only. But, Ayurveda medicinal Management has shown a remarkable recovery. .It may open a new path to the clinicians and researchers for finding the medicinal option for the treatment of Encysted hydrocele in child. Collectively, it can be concluded that the Ayurveda management may help to overcome on this issue.