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Thursday, March 11, 2010

Can you ever look at Water-balloons again?

An innocent comparison by a colleague has put me off water-balloons forever!

We had a male come into the clinic with long standing ascites (collection of fluid in his abdomen) due to liver problems. This was causing him extreme discomfort with breathing, as is known to happen in such cases. We decided the best course of action for him would be to do a tapping procedure (where we stick a needle into his abdomen and suck out fluid) and remove about a litre or two max. for some symptomatic relief.

My junior had never done one before, so I decided to teach it to her. I was needed in the O.T. anyway, so I thought I would start and leave her to monitor and finish the procedure once enough fluid came out.We got everything in place in the ward and started. It was clear straw coloured fluid, almost water like. It flowed easily and after the first 100cc or so I handed over my colleague. She was quite frightened (I don't blame her). As luck would have it, she must have moved the needle while trying to aspirate, and the fluid stopped draining. I was getting calls from the O.T. by now, so I showed her how to reposition the needle and left after confirming drainage again.

After about an hour or so, she phoned in the O.T. saying that the drainage stopped completely after 1 litre. She let the patient go. All went well, or so I thought. This is what I was faced with the next day when I entered the clinic.

The patient had now returned with what was being called a water-balloon by the staff. He developed a hydrocele secondary to ascitic tapping. 
A hydrocele is a collection of fluid in the scrotum. Most develop for no apparent reason, are harmless, and can be left alone. If needed, a small operation can usually cure the problem. This wasn't an ordinary hydrocele, and that's probably why they were referring to it as a water balloon. The fluid was as you can see bilateral and it was very very superficial. It moved like a water bed when touched. (sorry for the comparison but there is no better way to explain it)

I haven't read about such a thing ever, nor could I find it on the internet. If anyone knows of such a case, please do let me know. I am thinking of writing up a case report and sending it to a medical journal. The closest I've come to seeing something like this is at laparoscopic hernia repairs where the gas distends the scrotum!

Well, the person is much better now, the fluid has been absorbed and he will come again for his ascitic tap soon where I should be able to get a fresh picture to send a comparitive report to the journal.
Until such time, I'm off water balloons!

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