268 THE ABDOMEN AND PELVIS 



injure any of the superficial veins, as their dependent position 

 and the relief of tension following the operation may tend to 

 increase the amount of haemorrhage. 



In the radical cure of a hydrocele the approach is very similar 

 to that employed in varicocele (p. 262). The hydrocele is 

 pushed upwards into the wound, and the coverings are incised 

 and dissected off. The parietal layer of the tunica vaginalis is 

 cut away along the lines of its reflection on to the testis and 

 epididymis, or a vertical incision may be made in the tunica 

 vaginalis anteriorly, and the two halves may then be folded back- 

 wards so that their edges can be united behind the epididymis. 



Examination of the Testis and Spermatic Cord. The 

 shape and consistence of the testis can readily be appreciated 

 when it is examined in situ, and any alteration of the normal 

 elastic feel, or variation in size or shape, should be carefully 

 observed. The epididymis can be felt along the postero-lateral 

 border. Although it is usually fixed in position, the epididymis 

 can sometimes be moved independently of the testis and yet 

 may be otherwise normal. 



Enlargement of the tail (globus minor) of the epididymis is 

 not uncommonly associated with a bacterial infection ascending 

 along the ductus deferens from the urethra, such as occurs in 

 gonorrhoea. Tuberculous disease, on the other hand, usually 

 commences in the head (globus major), as the infection is carried 

 by the blood stream, and the bacilli settle down in the area 

 supplied by the epididymal branches of the internal spermatic 

 artery. 



When acutely inflamed, the epididymis becomes sausage- 

 shaped. It is greatly swollen and tends to surround the posterior 

 part of the testis, which, though also enlarged, is rather obscured. 

 On the other hand, in acute inflammatory conditions of the 

 testis, the swelling resembles a Jaffa orange in shape, and the 

 epididymis cannot be easily defined. Both these conditions 

 may be somewhat masked by an associated acute hydrocele. 



The ductus deferens can be felt along the postero-medial 

 border of the testis and may easily be distinguished in the 

 spermatic cord owing to its thick muscular wall. In tuberculous 

 disease, the duct is often irregularly thickened and its recognition 

 is still easier ; in varicocele, on the other hand, the increased 

 number and size of the veins may render its identification more 

 difficult. The presence of a hernial sac may be made out by 

 grasping the spermatic cord and allowing the individual structures 



