Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult

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It is an acquired congenital anomaly that is commonly observed in infants and children. Infected spermatic cord hydrocele has been reported on previously, but to the best of our knowledge, antibioma of spermatic cord hydrocele in adults has not yet been reported. In specific cases of long-standing abscesses, cartridge-based nucleic acid amplification test (CBNAAT) is used as the final diagnostic tool and can determine whether they are of tubercular pathology. Case: Here we are presenting a case of a 72-year-old male patient reporting to the surgery Outpatient Department, with complaints of swelling in the left inguinal region since birth, along with intermittent pain in the swelling for one year. It was diagnosed as antibioma and was confirmed to be of tubercular origin by CBNAAT following surgical exploration. The patient was started on anti-tubercular management as per the National Tuberculosis Elimination Programme protocol. Conclusions: Long standing abscesses are mostly tuberculous. We must look into whether they need urgent attention or can be managed conservatively as a routine procedure." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/12-1233/v1", "name": "Case Report: Tuberculosis in hydrocele of the spermatic cord in an..." } } ] } Home Browse Case Report: Tuberculosis in hydrocele of the spermatic cord in an... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Gharde P, Koul S, Lamture Y and Badwaik N. Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.12688/f1000research.137709.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] Pankaj Gharde https://orcid.org/0000-0002-3770-9991 1 , Shalinder Koul 2 , Yeshwant Lamture https://orcid.org/0000-0002-4876-3686 1 , Nitesh Badwaik 1 Pankaj Gharde https://orcid.org/0000-0002-3770-9991 1 , Shalinder Koul 2 , Yeshwant Lamture https://orcid.org/0000-0002-4876-3686 1 , Nitesh Badwaik 1 PUBLISHED 27 Sep 2023 Author details Author details 1 Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India 2 Department of General Surgery, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, 122505, India Pankaj Gharde Roles: Conceptualization, Writing – Original Draft Preparation Shalinder Koul Roles: Resources, Writing – Review & Editing Yeshwant Lamture Roles: Writing – Review & Editing Nitesh Badwaik Roles: Investigation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract Background: Antibioma is a loculated collection in the spermatic cord, which is generally a transparent sterile fluid located above the testis in the inguinal region. It is an acquired congenital anomaly that is commonly observed in infants and children. Infected spermatic cord hydrocele has been reported on previously, but to the best of our knowledge, antibioma of spermatic cord hydrocele in adults has not yet been reported. In specific cases of long-standing abscesses, cartridge-based nucleic acid amplification test (CBNAAT) is used as the final diagnostic tool and can determine whether they are of tubercular pathology. Case: Here we are presenting a case of a 72-year-old male patient reporting to the surgery Outpatient Department, with complaints of swelling in the left inguinal region since birth, along with intermittent pain in the swelling for one year. It was diagnosed as antibioma and was confirmed to be of tubercular origin by CBNAAT following surgical exploration. The patient was started on anti-tubercular management as per the National Tuberculosis Elimination Programme protocol. Conclusions: Long standing abscesses are mostly tuberculous. We must look into whether they need urgent attention or can be managed conservatively as a routine procedure. READ ALL READ LESS Keywords Spermatic Cord, Infected Cyst, Antibioma, Tubercular cavity Corresponding Author(s) Pankaj Gharde ( [email protected] ) Close Corresponding author: Pankaj Gharde Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2023 Gharde P et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Gharde P, Koul S, Lamture Y and Badwaik N. Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.12688/f1000research.137709.1 ) First published: 27 Sep 2023, 12 :1233 ( https://doi.org/10.12688/f1000research.137709.1 ) Latest published: 27 Sep 2023, 12 :1233 ( https://doi.org/10.12688/f1000research.137709.1 ) Introduction Congenital hydrocele, hernia and hydrocele of cord are generally seen in infants and young adults, but it is a rare finding in older adults. A lot of people do not come to clinics or take consultations as the swellings are symptomless and the disease does not affect them in their day-to-day activities. Hydrocele of cord is the fusion of patent processus vaginalis on both ends with the presence of fluid inside. The fluid present is usually sterile as there is no breach in continuity of the peritoneum and hence it does not get infected. 1 The fluid inside the sac generally remains sterile and very rarely surgeons come across infected hydrocele. Long-term use of antibiotics can convert this fluid into sterile pus known as antibioma. 2 The differential diagnosis of such swellings can be done using various modalities of investigations. Literature suggests that the best investigations are ultrasonography for differential diagnosis, color doppler to rule out arteriovenous malformation, computed tomography (CT) scan and magnetic resonance imaging (MRI) to rule out obstructed hernia, abdominal communication and pathologies leading to abscess. 3 These investigations when done in tandem or subsequently, can help in finalizing the treatment modality, based on the findings. In specific cases of long-standing abscesses, cartridge-based nucleic acid amplification test (CBNAAT) is used as the final diagnostic tool. 4 Hydrocele of cord is symptomless until and unless there is any trauma or infection. In the case of older men, we also have to rule out obstructed or Richter hernia. For this purpose, ultrasonography and CT scan can be highly useful. 3 Case report A72 year old male patient, farmer by occupation, resident of rural area of Wardha District, Maharashtra, Central India, presented to the Surgery Outpatient Department of Acharya Vinoba Bhave Rural Hospital at Wardha, with a mild painful swelling in the left inguinal region that had been present for one year and chronic infection of hydrocele of cord. The swelling in the left inguinal region was present since birth, but the patient did not experience any disturbing symptoms until the previous year. In February 2022, the patient experienced sudden pain associated with this swelling and a fever of 102°F. He visited a local physician, and was prescribed tablet pantoprazole 40 mg OD, tablet diclofenac sodium 50 mg BD and tablet amoxicillin + clavulanic acid 500 mg + 125 mg for five days, and was given a referral to a higher center for diagnosis and management. However, as he felt better the next morning, he delayed his visit to the higher center. The pain subsided and according to the history given by patient, recurred just once or twice every two months. The patient continued with the symptomatic management prescribed by his clinician without any repeat consultations. He took over-the-counter medications. Finally in April 2023, the patient came to us with complaints of pain with swelling since the last one year. On examination, the patient had a swelling measuring 7 × 10 cm in the left inguinal region ( Figure 1 ). It was soft cystic, had restricted mobility and was mobile only on pulling the testis downwards, clearly indicating hydrocele of cord. The swelling was not tender and the temperature over the swelling was not raised. Figure 1. Swelling in inguinal region. The transillumination test on the swelling was absent, indicating that the fluid present in the swelling is turbid and light cannot pass through it. The scrotum was normal and no inguinal lymph nodes were palpable on either sides of the inguinal region. Patient’s vitals were normal and all the laboratory investigations came to be within the normal limits. Ultrasonography report showed infected cystic collection in the spermatic cord. Abdominal ultrasound was normal. We decided to explore it, for which the fitness for the surgery was obtained from the Anesthesia Department. On exploration, the sac was adhered to the spermatic cord. While exploring the sac, we found that the cyst was adhered to the spermatic cord ( Figure 2 ), it ruptured during handling ( Figure 3 ). We excised the remnants of the sac. The remnants of the sac were excised, pus was sent for culture and sensitivity analysis while the cyst wall was sent for histopathology reporting. The wound was kept open with the intention of secondary healing. After a few days when it became clean and covered with red granulation tissue, we closed the cavity with polyglactin 2-0 and Nylon 3-0 ( Figure 3 ). Pre-operative and post-operative antibiotics were administered. The report for culture sensitivity came to be sterile and the histopathological report showed chronic granulomatous infection. Figure 2. Cyst identified on surgical exploration. Figure 3. Ruptured sac. Considering the chronicity of the swelling and the presence of abscesses we decided to rule out tuberculosis, hence CBNAAT was our choice. CBNAAT reporting confirmed that the swelling and abscess was tubercular in origin. As the reports confirmed our diagnosis of antibioma and tubercular cavity, the patient was started on with antitubercular management. The sutures were removed on the 10 th and 11 th post-operative days and the discharge of the patient was without any immediate surgical complications. As documented, tuberculous cavities, ulcers and wounds do not heal without any anti-tubercular treatment, but in this case the patient showed good early healing, to our surprise. The patient was satisfied and comfortable with our management and decided to extend his hospital stay until the stitch removal, although we wanted to discharge him on the fourth post-operative day. Discussion Congenital swelling, that is hydrocele of cord presenting in a 72-year-old male patient is rare by itself. While a diagnosed antibioma confirmed to be of tuberculous origin by CBNAAT is an additional unusual finding. Infected hydrocele of cord may result from the intrabdominal infection through patent processus vaginalis. It may also be a result of lower urinary tract infection, epididymo-orchitis, incarcerated inguinal hernia, appendicitis or any other abdominal infection. In routine cases it cannot be treated by conservative management and surgery is a must in all the cases of hydrocele of cord. 5 It may remain dormant for years if not treated and only in very few cases it may convert into abscesses. As we are in a developing country, the socioeconomically poor patients in rural areas may never attend the hospital until or unless they suffer from major discomfort or are scared of malignancy or death. 6 This is exactly what happened in this case as the patient was lingering on the disease but when it did not subside even after conservative treatment for about a year, that is when he decided to come to the surgery outpatient department. Clearly indicating the lack of health seeking behavior in low and middle-income countries. We could not find any primary cause of infection leading to this abscess. The team looked at the condition from different angles and narrowed down on tuberculosis considering the presentation and chronicity. Taking a decision to explore the antibioma and suspecting an infection of tubercular origin helped us diagnose and manage the case appropriately. The complications of inguinal hernia area such as incarcerated hernia, abscess, malignant lymph nodes and cellulitis should be attended on priority basis as some times they may be underdiagnosed, some cases may need urgent consideration otherwise they may prove fatal. 7 As mentioned, hydrocele of cord is detected in early life and patients usually get operated at an early age. Very rarely would you come across an older patient presenting with this condition. As the swelling was present since birth i.e. , most probably congenital in origin, it must have caused discomfort to the patient, but peculiarly the patient went through adulthood without any seemingly obvious discomfort that would have initiated seeking any medical assistance. The investigations needed for the swelling in this region include CT scan and MRI of the abdomen to rule out hernia, especially an obstructed one. Second line of investigations must be ultrasonography to differentiate between a cystic swelling or solid swelling. If it turns out to be solid; fine needle aspiration cytology (FNAC) or excision biopsy is needed. If it is cystic, either aspiration or excision should be done. A CT scan and MRI are essential for ruling out abdominal pathologies too, which may lead to infected hydrocele of cord. 2 For the control of infection, systemic antibiotics can be given along with analgesics, anti-inflammatories along with other symptomatic management. 8 In pyogenic abscess, the treatment of choice is incision and drainage, but in cases of tubercular abscess an anti-gravity aspiration of the abscess followed by antitubercular management will suffice. 9 Any chronic abscess present for a long duration should raise suspicions of tuberculosis. CBNAAT examination of fluid is a test that gives a report within two hours and is available at many centers, it is a useful test to diagnose extrapulmonary tuberculosis. Tuberculoma and antibioma of spermatic cord is a rare presentation that we wanted to highlight, as clinicians should also keep it as a differential diagnosis in such types of cases. Furthermore, it is an inspiration for a surgeon to explore the unresolved mysteries in human bodies. Conclusions Long standing abscess are mostly tuberculous. In a case of inguinal or inguinoscrotal swelling it is necessary to diagnose it properly. We must look into whether it needs urgent attention or can be managed conservatively as a routine procedure. Every aspect must be scrutinized with necessary investigations and appropriate decisions should be taken and followed by definitive management so that nothing is neglected. Medical science is vast and knowledge must be shared amongst the medical professionals to build their opinions and for the best possible management. The patient was notified to the District Tuberculosis Centre and was started on anti-tuberculosis drugs under the National Tuberculosis Elimination Programme. Consent Written informed consent for publication of their clinical details and clinical images was obtained from the patient. Data availability Underlying data All data underlying the results are available as part of the article and no additional source data are required. References 1. Costantino E, Ganesan GS, Plaire JC: Abdominoscrotal hydrocele in an infant boy. BMJ Case Rep. 2017 May 27; 2017 : bcr2017220370. PubMed Abstract | Publisher Full Text | Free Full Text 2. Patel RV, Brown LM, More B, et al. : Neonatal-perforated appendix forming antibioma masquerading as duodenal duplication. BMJ Case Rep. 2013 Jul 29; 2013 : bcr2013200067. PubMed Abstract | Publisher Full Text | Free Full Text 3. Shadbolt CL, Heinze SB, Dietrich RB: Imaging of groin masses: inguinal anatomy and pathologic conditions revisited. Radiographics. 2001 Oct; 21 : S261–S271. 21 Spec No:S261-71. PubMed Abstract | Publisher Full Text 4. Sachdeva K, Shrivastava T: CBNAAT: A Boon for Early Diagnosis of Tuberculosis-Head and Neck. Indian J. Otolaryngol. Head Neck Surg. 2018 Dec; 70 (4): 572–577. PubMed Abstract | Publisher Full Text | Free Full Text 5. Kohlhauser M, Pirsch JV, Maier T, et al. : The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature. Medicina (Kaunas). 2022 Sep 27; 58 (10): 1353. PubMed Abstract | Publisher Full Text | Free Full Text 6. Dean L, Tolhurst R, Nallo G, et al. : Neglected tropical disease as a ‘biographical disruption’: Listening to the narratives of affected persons to develop integrated people centred care in Liberia. PLoS Negl. Trop. Dis. 2019 Sep 6; 13 (9): e0007710. PubMed Abstract | Publisher Full Text | Free Full Text 7. Wani I, Rather M, Naikoo G, et al. : Encysted hydrocele of cord in an adult misdiagnosed as irreducible hernia: a case report. Oman Med. J. 2009 Jul; 24 (3): 218–219. PubMed Abstract | Publisher Full Text | Free Full Text 8. Tiveron AP, Rosalen PL, Franchin M, et al. : Chemical Characterization and Antioxidant, Antimicrobial, and Anti-Inflammatory Activities of South Brazilian Organic Propolis. PLoS One. 2016 Nov 1; 11 (11): e0165588. PubMed Abstract | Publisher Full Text | Free Full Text 9. Natali D, Cloatre G, Brosset C, et al. : What pulmonologists need to know about extrapulmonary tuberculosis. Breathe (Sheff.). 2020 Dec; 16 (4): 200216. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Sep 2023 ADD YOUR COMMENT Comment Author details Author details 1 Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India 2 Department of General Surgery, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, 122505, India Pankaj Gharde Roles: Conceptualization, Writing – Original Draft Preparation Shalinder Koul Roles: Resources, Writing – Review & Editing Yeshwant Lamture Roles: Writing – Review & Editing Nitesh Badwaik Roles: Investigation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 27 Sep 2023, 12:1233 https://doi.org/10.12688/f1000research.137709.1 Copyright © 2023 Gharde P et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Gharde P, Koul S, Lamture Y and Badwaik N. Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.12688/f1000research.137709.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 27 Sep 2023 Views 0 Cite How to cite this report: Gadelkareem RA. Reviewer Report For: Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.5256/f1000research.150874.r243130 ) The direct URL for this report is: https://f1000research.com/articles/12-1233/v1#referee-response-243130 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Feb 2024 Rabea Ahmed Gadelkareem , Department of Urology, Assiut Urology and Nephrology Hospital, Assiut University, Asyut, Assiut Governorate, Egypt Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.150874.r243130 The authors presented a case of tuberculous pyocele of the encysted hydrocele of the spermatic cord in a 72-year-old patient. The swelling was dated since birth, but pain and fever occurred only within the last year. Relative to the long-standing ... Continue reading READ ALL The authors presented a case of tuberculous pyocele of the encysted hydrocele of the spermatic cord in a 72-year-old patient. The swelling was dated since birth, but pain and fever occurred only within the last year. Relative to the long-standing history of swelling, a high index of suspicion of tuberculosis was prominent. Surgical excision was performed, using CBNAAT. Many concerns and errors need to be addressed: 1) The title needs to be re-designed. I suggest re-writing as Tuberculous pyocele complicating a hydrocele of the spermatic cord in an adult: a case report. 2) Abstract-Background: The definition of antibioma is not correct. 3) The description (acquired congenital) should be corrected. There is no acquired congenital at the same time. 4) Case report: A 72 year should be corrected to be: A 72-year-old. 5) Revise the methods: there are many unsuitable terms (adhered to be adherent; the patient was started to be the patient started the anti-tuberculous regimen. 6) Laboratory workups, such as Complete blood count, blood sugar, and other organ function tests should be provided. 7) Workups to investigate the origin of this TB infection: Exclusion of pulmonary TB needs to be provided. 8) Discussion: You may provide a discussion about the other TB forms of the spermatic cord. 9) Conclusion: The last sentence is not suitable for this part. It would be better to be transferred to the section of the Case report. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Rare urological cases; Kidney transplantation; stones and endourology. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Gadelkareem RA. Reviewer Report For: Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.5256/f1000research.150874.r243130 ) The direct URL for this report is: https://f1000research.com/articles/12-1233/v1#referee-response-243130 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Palinrungi MA. Reviewer Report For: Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.5256/f1000research.150874.r243136 ) The direct URL for this report is: https://f1000research.com/articles/12-1233/v1#referee-response-243136 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Feb 2024 Muhammad Asykar Palinrungi , Department of Surgery, Hasanuddin University, Makassar, South Sulawesi, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.150874.r243136 Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients 1. Because this is a single case report, it limits the generalizability of the ... Continue reading READ ALL Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients 1. Because this is a single case report, it limits the generalizability of the findings. 2. It is necessary to compare other cases that have existed, both in terms of diagnosis and therapy in patients with cases like this. 3. The use of anti-gravity aspiration for tubercular abscesses is a unique approach that may not be widely applicable or feasible in all clinical settings. 4. Need to explain a detailed description of the patient's follow-up and long-term outcomes, which could provide valuable information for future research and practice. 5. This report does not discuss any potential limitations or biases in the study design or methodology, which could impact the validity of the findings. 6. It's best to use references from the last 5-10 years. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: urology, pediatric urology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Palinrungi MA. Reviewer Report For: Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.5256/f1000research.150874.r243136 ) The direct URL for this report is: https://f1000research.com/articles/12-1233/v1#referee-response-243136 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 13 Apr 2024 Pankaj Gharde , Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 13 Apr 2024 Author Response Dear Sir, I am humbly responding to it one by one in sequence in Italiacs below each query. Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain ... Continue reading Dear Sir, I am humbly responding to it one by one in sequence in Italiacs below each query. Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients. 1. First of all, it is not a primary hydrocele, it is a Hydrocele of the cord, described appropriately in the 4th and 5th lines of 'background' 1. Because this is a single case report, it limits the generalizability of the findings. 2. Hydrocele of the cord is found commonly in Indian scenarios, it is taught in almost every teaching encounter of congenital hernia and hydrocele, yet we can't suspect Tuberculosis in every case, especially if it is a congenital swelling. In this case it was not expected to be tuberculosis of hydrocele of the spermatic cord in the initial stages, only after the swelling ruptured and we found mild exudate fluid instead of clear fluid. 2. It is necessary to compare other cases that have existed, both in terms of diagnosis and therapy in patients with cases like this. As far as we have searched the literature we could not find a single case of Tuberculosis of hydrocele of cord. 3. The use of anti-gravity aspiration for tubercular abscesses is a unique approach that may not be widely applicable or feasible in all clinical settings. 3. Dear Sir, we don't do incision and drainage of tubercular abscesses, as recommended in the management of tuberculous abscess, we perform anti-gravity aspiration for tubercular abscesses, and for aspiration, we should be confirmed of it. In our case, it was not suspected to be a tubercular abscess, as a doubt in our mind, the fluid was turbid, and it was having room temperature which usually happens in a tubercular abscess in contrast to a pyogenic abscess. It was confirmed after 2 days of surgery as we sent its sample for CBNAAT(because of our doubt), but it was not a confirmed case of Tuberculosis. secondly, if it is a confirmed case of Tuberculosis, in that case, we do antigravity aspirate otherwise it may form a continuous draining sinus, which does not heal easily. 4. Need to explain a detailed description of the patient's follow-up and long-term outcomes, which could provide valuable information for future research and practice. 4. As we operated the case and when the CBNAAT of the sample came positive, we started with DOTs, the wound is healed patient was taking DOTs treatment for it, we started writing this case report on the third day of the operation and the follow up could not be mentioned here. 5. This report does not discuss any potential limitations or biases in the study design or methodology, which could impact the validity of the findings. As it is not a research article, it needs an aim, objectives, methodology study design, data collection, data entry in master chart, statistical analysis, and then limitations( All these are part of the Original article, not a Case report. so it is not possible here to mention in case report) 6. It's best to use references from the last 5-10 years. Except for reference No. 7 which is from 2009, the rest are recent ones, kindly confirm. Thanks for your queries, I think my humble replies are enough to clear your doubts. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Dear Sir, I am humbly responding to it one by one in sequence in Italiacs below each query. Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients. 1. First of all, it is not a primary hydrocele, it is a Hydrocele of the cord, described appropriately in the 4th and 5th lines of 'background' 1. Because this is a single case report, it limits the generalizability of the findings. 2. Hydrocele of the cord is found commonly in Indian scenarios, it is taught in almost every teaching encounter of congenital hernia and hydrocele, yet we can't suspect Tuberculosis in every case, especially if it is a congenital swelling. In this case it was not expected to be tuberculosis of hydrocele of the spermatic cord in the initial stages, only after the swelling ruptured and we found mild exudate fluid instead of clear fluid. 2. It is necessary to compare other cases that have existed, both in terms of diagnosis and therapy in patients with cases like this. As far as we have searched the literature we could not find a single case of Tuberculosis of hydrocele of cord. 3. The use of anti-gravity aspiration for tubercular abscesses is a unique approach that may not be widely applicable or feasible in all clinical settings. 3. Dear Sir, we don't do incision and drainage of tubercular abscesses, as recommended in the management of tuberculous abscess, we perform anti-gravity aspiration for tubercular abscesses, and for aspiration, we should be confirmed of it. In our case, it was not suspected to be a tubercular abscess, as a doubt in our mind, the fluid was turbid, and it was having room temperature which usually happens in a tubercular abscess in contrast to a pyogenic abscess. It was confirmed after 2 days of surgery as we sent its sample for CBNAAT(because of our doubt), but it was not a confirmed case of Tuberculosis. secondly, if it is a confirmed case of Tuberculosis, in that case, we do antigravity aspirate otherwise it may form a continuous draining sinus, which does not heal easily. 4. Need to explain a detailed description of the patient's follow-up and long-term outcomes, which could provide valuable information for future research and practice. 4. As we operated the case and when the CBNAAT of the sample came positive, we started with DOTs, the wound is healed patient was taking DOTs treatment for it, we started writing this case report on the third day of the operation and the follow up could not be mentioned here. 5. This report does not discuss any potential limitations or biases in the study design or methodology, which could impact the validity of the findings. As it is not a research article, it needs an aim, objectives, methodology study design, data collection, data entry in master chart, statistical analysis, and then limitations( All these are part of the Original article, not a Case report. so it is not possible here to mention in case report) 6. It's best to use references from the last 5-10 years. Except for reference No. 7 which is from 2009, the rest are recent ones, kindly confirm. Thanks for your queries, I think my humble replies are enough to clear your doubts. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interest. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 13 Apr 2024 Pankaj Gharde , Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 13 Apr 2024 Author Response Dear Sir, I am humbly responding to it one by one in sequence in Italiacs below each query. Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain ... Continue reading Dear Sir, I am humbly responding to it one by one in sequence in Italiacs below each query. Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients. 1. First of all, it is not a primary hydrocele, it is a Hydrocele of the cord, described appropriately in the 4th and 5th lines of 'background' 1. Because this is a single case report, it limits the generalizability of the findings. 2. Hydrocele of the cord is found commonly in Indian scenarios, it is taught in almost every teaching encounter of congenital hernia and hydrocele, yet we can't suspect Tuberculosis in every case, especially if it is a congenital swelling. In this case it was not expected to be tuberculosis of hydrocele of the spermatic cord in the initial stages, only after the swelling ruptured and we found mild exudate fluid instead of clear fluid. 2. It is necessary to compare other cases that have existed, both in terms of diagnosis and therapy in patients with cases like this. As far as we have searched the literature we could not find a single case of Tuberculosis of hydrocele of cord. 3. The use of anti-gravity aspiration for tubercular abscesses is a unique approach that may not be widely applicable or feasible in all clinical settings. 3. Dear Sir, we don't do incision and drainage of tubercular abscesses, as recommended in the management of tuberculous abscess, we perform anti-gravity aspiration for tubercular abscesses, and for aspiration, we should be confirmed of it. In our case, it was not suspected to be a tubercular abscess, as a doubt in our mind, the fluid was turbid, and it was having room temperature which usually happens in a tubercular abscess in contrast to a pyogenic abscess. It was confirmed after 2 days of surgery as we sent its sample for CBNAAT(because of our doubt), but it was not a confirmed case of Tuberculosis. secondly, if it is a confirmed case of Tuberculosis, in that case, we do antigravity aspirate otherwise it may form a continuous draining sinus, which does not heal easily. 4. Need to explain a detailed description of the patient's follow-up and long-term outcomes, which could provide valuable information for future research and practice. 4. As we operated the case and when the CBNAAT of the sample came positive, we started with DOTs, the wound is healed patient was taking DOTs treatment for it, we started writing this case report on the third day of the operation and the follow up could not be mentioned here. 5. This report does not discuss any potential limitations or biases in the study design or methodology, which could impact the validity of the findings. As it is not a research article, it needs an aim, objectives, methodology study design, data collection, data entry in master chart, statistical analysis, and then limitations( All these are part of the Original article, not a Case report. so it is not possible here to mention in case report) 6. It's best to use references from the last 5-10 years. Except for reference No. 7 which is from 2009, the rest are recent ones, kindly confirm. Thanks for your queries, I think my humble replies are enough to clear your doubts. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Dear Sir, I am humbly responding to it one by one in sequence in Italiacs below each query. Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients. 1. First of all, it is not a primary hydrocele, it is a Hydrocele of the cord, described appropriately in the 4th and 5th lines of 'background' 1. Because this is a single case report, it limits the generalizability of the findings. 2. Hydrocele of the cord is found commonly in Indian scenarios, it is taught in almost every teaching encounter of congenital hernia and hydrocele, yet we can't suspect Tuberculosis in every case, especially if it is a congenital swelling. In this case it was not expected to be tuberculosis of hydrocele of the spermatic cord in the initial stages, only after the swelling ruptured and we found mild exudate fluid instead of clear fluid. 2. It is necessary to compare other cases that have existed, both in terms of diagnosis and therapy in patients with cases like this. As far as we have searched the literature we could not find a single case of Tuberculosis of hydrocele of cord. 3. The use of anti-gravity aspiration for tubercular abscesses is a unique approach that may not be widely applicable or feasible in all clinical settings. 3. Dear Sir, we don't do incision and drainage of tubercular abscesses, as recommended in the management of tuberculous abscess, we perform anti-gravity aspiration for tubercular abscesses, and for aspiration, we should be confirmed of it. In our case, it was not suspected to be a tubercular abscess, as a doubt in our mind, the fluid was turbid, and it was having room temperature which usually happens in a tubercular abscess in contrast to a pyogenic abscess. It was confirmed after 2 days of surgery as we sent its sample for CBNAAT(because of our doubt), but it was not a confirmed case of Tuberculosis. secondly, if it is a confirmed case of Tuberculosis, in that case, we do antigravity aspirate otherwise it may form a continuous draining sinus, which does not heal easily. 4. Need to explain a detailed description of the patient's follow-up and long-term outcomes, which could provide valuable information for future research and practice. 4. As we operated the case and when the CBNAAT of the sample came positive, we started with DOTs, the wound is healed patient was taking DOTs treatment for it, we started writing this case report on the third day of the operation and the follow up could not be mentioned here. 5. This report does not discuss any potential limitations or biases in the study design or methodology, which could impact the validity of the findings. As it is not a research article, it needs an aim, objectives, methodology study design, data collection, data entry in master chart, statistical analysis, and then limitations( All these are part of the Original article, not a Case report. so it is not possible here to mention in case report) 6. It's best to use references from the last 5-10 years. Except for reference No. 7 which is from 2009, the rest are recent ones, kindly confirm. Thanks for your queries, I think my humble replies are enough to clear your doubts. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interest. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Sep 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 27 Sep 23 read read Muhammad Asykar Palinrungi , Hasanuddin University, Makassar, Indonesia Rabea Ahmed Gadelkareem , Assiut Urology and Nephrology Hospital, Assiut University, Asyut, Egypt Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Gadelkareem R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Feb 2024 | for Version 1 Rabea Ahmed Gadelkareem , Department of Urology, Assiut Urology and Nephrology Hospital, Assiut University, Asyut, Assiut Governorate, Egypt 0 Views copyright © 2024 Gadelkareem R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors presented a case of tuberculous pyocele of the encysted hydrocele of the spermatic cord in a 72-year-old patient. The swelling was dated since birth, but pain and fever occurred only within the last year. Relative to the long-standing history of swelling, a high index of suspicion of tuberculosis was prominent. Surgical excision was performed, using CBNAAT. Many concerns and errors need to be addressed: 1) The title needs to be re-designed. I suggest re-writing as Tuberculous pyocele complicating a hydrocele of the spermatic cord in an adult: a case report. 2) Abstract-Background: The definition of antibioma is not correct. 3) The description (acquired congenital) should be corrected. There is no acquired congenital at the same time. 4) Case report: A 72 year should be corrected to be: A 72-year-old. 5) Revise the methods: there are many unsuitable terms (adhered to be adherent; the patient was started to be the patient started the anti-tuberculous regimen. 6) Laboratory workups, such as Complete blood count, blood sugar, and other organ function tests should be provided. 7) Workups to investigate the origin of this TB infection: Exclusion of pulmonary TB needs to be provided. 8) Discussion: You may provide a discussion about the other TB forms of the spermatic cord. 9) Conclusion: The last sentence is not suitable for this part. It would be better to be transferred to the section of the Case report. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Rare urological cases; Kidney transplantation; stones and endourology. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Gadelkareem RA. Peer Review Report For: Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.5256/f1000research.150874.r243130) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1233/v1#referee-response-243130 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Palinrungi M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Feb 2024 | for Version 1 Muhammad Asykar Palinrungi , Department of Surgery, Hasanuddin University, Makassar, South Sulawesi, Indonesia 0 Views copyright © 2024 Palinrungi M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients 1. Because this is a single case report, it limits the generalizability of the findings. 2. It is necessary to compare other cases that have existed, both in terms of diagnosis and therapy in patients with cases like this. 3. The use of anti-gravity aspiration for tubercular abscesses is a unique approach that may not be widely applicable or feasible in all clinical settings. 4. Need to explain a detailed description of the patient's follow-up and long-term outcomes, which could provide valuable information for future research and practice. 5. This report does not discuss any potential limitations or biases in the study design or methodology, which could impact the validity of the findings. 6. It's best to use references from the last 5-10 years. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise urology, pediatric urology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 13 Apr 2024 Pankaj Gharde, Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India Dear Sir, I am humbly responding to it one by one in sequence in Italiacs below each query. Abstract: first talk about hydrocele, then explain about antibioma. case reports; explain how you diagnose and act as well as follow up on patients. 1. First of all, it is not a primary hydrocele, it is a Hydrocele of the cord, described appropriately in the 4th and 5th lines of 'background' 1. Because this is a single case report, it limits the generalizability of the findings. 2. Hydrocele of the cord is found commonly in Indian scenarios, it is taught in almost every teaching encounter of congenital hernia and hydrocele, yet we can't suspect Tuberculosis in every case, especially if it is a congenital swelling. In this case it was not expected to be tuberculosis of hydrocele of the spermatic cord in the initial stages, only after the swelling ruptured and we found mild exudate fluid instead of clear fluid. 2. It is necessary to compare other cases that have existed, both in terms of diagnosis and therapy in patients with cases like this. As far as we have searched the literature we could not find a single case of Tuberculosis of hydrocele of cord. 3. The use of anti-gravity aspiration for tubercular abscesses is a unique approach that may not be widely applicable or feasible in all clinical settings. 3. Dear Sir, we don't do incision and drainage of tubercular abscesses, as recommended in the management of tuberculous abscess, we perform anti-gravity aspiration for tubercular abscesses, and for aspiration, we should be confirmed of it. In our case, it was not suspected to be a tubercular abscess, as a doubt in our mind, the fluid was turbid, and it was having room temperature which usually happens in a tubercular abscess in contrast to a pyogenic abscess. It was confirmed after 2 days of surgery as we sent its sample for CBNAAT(because of our doubt), but it was not a confirmed case of Tuberculosis. secondly, if it is a confirmed case of Tuberculosis, in that case, we do antigravity aspirate otherwise it may form a continuous draining sinus, which does not heal easily. 4. Need to explain a detailed description of the patient's follow-up and long-term outcomes, which could provide valuable information for future research and practice. 4. As we operated the case and when the CBNAAT of the sample came positive, we started with DOTs, the wound is healed patient was taking DOTs treatment for it, we started writing this case report on the third day of the operation and the follow up could not be mentioned here. 5. This report does not discuss any potential limitations or biases in the study design or methodology, which could impact the validity of the findings. As it is not a research article, it needs an aim, objectives, methodology study design, data collection, data entry in master chart, statistical analysis, and then limitations( All these are part of the Original article, not a Case report. so it is not possible here to mention in case report) 6. It's best to use references from the last 5-10 years. Except for reference No. 7 which is from 2009, the rest are recent ones, kindly confirm. Thanks for your queries, I think my humble replies are enough to clear your doubts. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes View more View less Competing Interests No competing interest. reply Respond Report a concern Palinrungi MA. Peer Review Report For: Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult [version 1; peer review: 2 approved with reservations] . F1000Research 2023, 12 :1233 ( https://doi.org/10.5256/f1000research.150874.r243136) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1233/v1#referee-response-243136 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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