Abdominoscrotal hydrocoeles: little place for conservatism

Abstract

Abdominoscrotal hydrocoeles (ASH) are infrequently reported in children. The presence of bilateral ASH is even rarer, with fewer than five cases reported to date. ASH are present at birth and tend to be progressive in nature. Spontaneous resolution has not been documented. The pathogenesis is uncertain and their presence in the neonatal period suggests a preformed abnormality of the processus vaginalis. Diagnosis is suspected on clinical examination and confirmed by ultrasonography, which is a reliable diagnostic tool. Undescended testes frequently coexist. Early surgery is the preferred management, and complications are frequent if left unattended. Surgery is simply an extension of a hernia operation, without the need for a laparotomy.

Early Diagnosis and Management of Neonatal Abdominoscrotal Hydroceles

“…Our first case clearly demonstrated a potential flap valve mechanism by compression of the wall of the hydrocele sac against the processus vaginalis. This differs from several recent reports of neonatal hydrocele in which no patent processus vaginalis could be demonstrated [5,6,8].…”

“…The progressive enlargement of the hydrocele sac can be extensive and reach the level of the kidney [5]. Testicular dysmorphism has been found in both of the present cases and has become increasingly associated with ASHs [1,6].…”

“…In adults, tense abdominoscrotal hydroceles are associated with partial or complete arrest of spermatogenesis in 18% of patients [7]. Other reported complications of abdominoscrotal hydroceles include leg edema and hydronephrosis from compression on the iliac vein or ureter, respectively [5].…”

Both-sided Large Abdominoscrotal Hydrocele Associated with Testicles Atrophy

“…Considering the complications associated with abdominoscrotal hydrocele such as ureterohydronephrosis (10), acute appendicitis (2), testicular dismorphysm (11) and paratesticular malign mezoteliom (12), surgical treatment as selected treatment is recommended after the establishment of the exact diagnosis (13). Some authors (3) developed and proposed algorithm for treatment of abdominoscrotal hydrocele, which included the option of conservative treatment and monitoring of such children from neonatal period for several months, in expectation of spontaneous resolution.…”

Giant unilateral abdominoscrotal hydrocele in an adult: Case report

“…The abdominal component lies latero-and retroperitoneally, and is variable in size, but may be extensive, reaching up to the inferior pole of the kidney [2]. Abdominoscrotal hydrocele was first described by Dupuytren in 1834 [15].…”