Bell Clapper Deformity Pictures, Test, Symptoms, Causes, Treatment

Bell Clapper Deformity is a congenital anatomical disorder in which there is an innate lack of gubernaculum, the back fixation of the tunica vaginalis to the scrotum. With bell clapper deformity, testicles are poorly connected to the scrotum and able to move freely in the scrotal sack and bend around the axis of the blood vessels. Bell clapper deformity is usually bilateral in about 60% to 70% of such cases.

Bell clapper deformity leaves testicles  to rotate and swing within tunica vaginalis just like clapper inside of a bell. This condition may lead to testicular torsion around the axis of the seminal cord that is termed as spermatic cord torsion.

Deformation itself is difficult to detect from radiographic images. However, there are some specific findings in case of MRI for example an abnormal direction of the longitudinal axis of the testicles and irregular pattern of fluid collection inside the cavity of tunica vaginalis.

About 40% to 60% cases of Bell clapper deformity lead towards testicular torsion while rest of the cases does not cause torsion and ischemia. Torsion usually occurs when mesorchium becomes abnormally long and allows testicles to bend and twist around its own axis. Possible causes of bell clapper deformity and testicular torsion are forceful contraction of cremasteric muscle, trauma, sexual intercourse and strenuous activity.

 Bell Clapper Deformity Pictures



Bell Clapper Deformity Tests

It is difficult to diagnose bell clapper deformity via physical examination because it is cannot be observed with naked eye. For this purpose you healthcare provide may ask you you to perform some radiographic as well as sonographic test for clear diagnosis. Lower abdominal ultrasound with special focus to testicular region is beneficial in this regard. However, sometimes it is necessary to perform MRI if ultrasound does not provide adequate results.

Bell Clapper Deformity Symptoms

Symptoms of bell clapper deformity are not so much obvious unlike other testicular abnormalities. However, following signs must be kept in consideration as far as bell calpper deformity is concerned.
  • Presence of blood in semen
  • Nausea
  • Vomiting
  • Lumps in the scrotal region
  • Swelling in the scrotum
  • Lower abdominal pain
  • Painful urination

Bell clapper deformity Causes 

Bell calpper deformity may occur at any age with or without obvious cause. Some commonly known factors that results in bell clapper deformity are trauma, accidental injury to testes, birth defect, strenuous activity, cremasteric muscle stretchiness, cold temperature and aggressive testicle growth during puberty.

Bell clapper deformity Treatment

There is no therapeutic treatment for bell clapper deformity. Surgery is the mainstay for such problem. In this surgeon will make a small incision in your scrotum, untwist your spermatic cord and then stitch one or both testicles. Only 2-5% of the cases require removal of testicles due to secondary complications.
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Pneumaturia ICD-10, Definition, Symptoms, Causes, Treatment

Pneumaturia is the passage of gas into the urine. In patients who did not have a recent urinary tract procedure or urethral catheterization, it is almost always due to the fistula between the intestine and the bladder. Common causes include diverticulitis, colon carcinoma, regional enteritis (Crohn's disease). In rare cases, diabetic patients may have gas infections due carbon dioxide formation from fermentation of high urinary sugar concentrations.

First of all, there may be a rectovesical fistula. In these cases, there are usually presence of fecal matter in urine. Usually, it results from ruptured diverticulitis, ruptured appendix, or tumor that forms pelvic abscess gradually and spreads into the walls of bladder. Second, there may be a urinary tract infection with gas generating micro-organisms e.g E. coli.

Pus formation and bloody discharge is common is both types so further diagnosis is much necessary to make it confirm. The fistula can be diagnosed by intravenous pyelogram, cystoscopy or barium enema. Urine culture can show presence of micro-organisms in cases there is no fistula.

Though, it is a rare kind of disorder in clinical practice but it may lead to irreversible complications so, prompt treatment is much necessary to avoid secondary problems and in some cases surgical intervention is the only option left behind.

Pneumaturia ICD-10, Definition, Symptoms, Causes, Treatment

Pneumaturia Symptoms


Symptoms of pneumaturia are not same in all cases but following symptoms should be kept under consideration as far as pneumaturia is concerned.
  • Pus like discharge
  • Pain during urination
  • Presence of fecal matter in urine
  • Presence of air or bubbles in urine
  • Changes in the color of urine
  • Presence of blood in the urine
  • Bladder pain

Pneumaturia Causes


There are number of causes of pneumaturia that must be ruled out before starting any kind of therapeutic treatment. Fistula between the intestine and the bladder is at the top of the list in pneumaturia. Other causes that might be the main the main culprit are colon carcinoma, ruptured diverticulitis, diabetes, E.coli infection, and accidental injury or trauma.

Pneumaturia Treatment


Treatment of pneumaturia is depends upon the root cause. If patient is having such disorder due to infection then therapy of broad spectrum antibiotics is the mainstay to resolve this problem. Most commonly used antibiotics in UTI are quinolones, macrolides and cephalosporins.

Similarly, if it is happening due to any structural defect associated with trauma, injury etc then surgical intervention is mainstay to eradicate it completely. This options has some limitations as well e.g in case carcinoma cancer staging is very critical point. Early diagnosis makes it more possible to eliminate completely while later stages become resistant and chances of survival are less.

Pneumaturia ICD-10


Following code is used for Pneumaturia in ICD-10

R39.89--Other symptoms and signs involving the genitourinary system--Billable
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