Abdominoscrotal hydrocele: an insight into its origin

Abstract

Abdominoscrotal hydrocele is an hourglass hydrocele with both an inguinoscrotal and abdominal component. It is a rare surgical entity with few cases reported in the literature. We report a case of abdominoscrotal hydrocele that gives an insight into its pathogenesis.

Large abdominoscrotal hydrocele: Uncommon surgical entity

“…Though first described by Dupuytren as “hydrocele en bisac” in 1934; it was characterized and defined by Bickel in 1919 as abdominoscrotal hydrocele [1,2] . The first pediatric case was reported by Syme [1] . The exact etiology of abdominoscrotal hydrocele is not known.…”

“…However, the most accepted theory is the one by Dupuytren which suggests that excessive intracystic pressure causes cephalad extension of scrotal swelling through the deep inguinal ring [1] . Brodman described it to be because of high obliteration of processes vaginalis above the deep inguinal ring, leaving a high infantile hydrocele [1] .…”

“…In this test, pressure applied over the abdominal swelling causes increased pressure in the scrotal component and vice versa. It is also called “springing back ball” [1,5] . Clinically if a scrotal swelling is present in combination with abdominal swelling just above the inguinal ligament, then ASH should be suspected.…”

“… Highlights The exact etiology of abdominoscrotal hydrocele is not known. Many theories such as, valve theory [1,2] , diverticulum theory [1] , displacement as per Laplace’s law [3] and increased production or decreased resorption of fluid [4] have been described in literature to explain the pathogenesis of this rare surgical entity. Surgical excision is the only therapeutic option for ASH.…”

The Value of Laparoscopy in the Management of Abdominoscrotal Hydroceles

“…Although their etiology is not completely understood, most feel ASH originate as large scrotal hydroceles that expand over time through the inguinal canal into the extraperitoneal space. [2][3][4][5] Reports of spontaneous resolution are rare, and complications are well documented. These include testicular dysmorphism, 2,6 hydronephrosis, 2,3 testicular torsion, 4 lymphedema, 2 hemorrhage, 4 and paratesticular malignant mesothelioma.…”