Persistence of the processus vaginalis and its related disorders

Abstract

The processus vaginalis is a blind‐ended evagination of the abdominal wall that develops during fetal life and typically undergoes obliteration in early life. Persistence of the processus vaginalis is associated with a number of pathologies including congenital indirect inguinal hernias, communicating hydroceles, funicular and encysted hydroceles, canal of Nuck cysts, and acquired undescended testis. Whilst all are detectable sonographically, there is little educational material relevant to the field of ultrasound with much of the literature directed at surgical and primary care physicians. Furthermore, within the literature there is a lack of consensus on several areas including the anatomy and embryology of the processus vaginalis and the mechanisms behind its obliteration. As such the objective of this paper is to distil the information regarding the persistent processus vaginalis as it is relevant to ultrasound and in doing so address the literature gap for sonographers and sonologists. The anatomy and embryology of the persistent processus vaginalis will be discussed including causative mechanisms for anomalies with their sonographic appearance highlighted.

Amyand’s Hernia With Concurrent Appendicitis: A Case Report and Review of the Literature

“…Amyand's hernia is much more common in male patients. Congenital inguinal hernias have been reported to occur with a 6:1 male to female ratio [4]. Most case reports describe a right-sided Amyand's hernia, however, there have been some instances where the hernia has been left-sided.…”

Hydrocele of the Canal of Nuck: A Review

“…Type 1: An encysted hydrocele is a kind of cyst that develops as a consequence of partial obliteration of just the proximal portion of the canal of Nuck. Typical clinical presentation is a nonreducible, painless mass whose volume remains unchanged when the Valsalva maneuver is performed [ 11 ]. When there is an imbalance between fluid secretion and absorption, which can occur as a result of trauma, inflammation, or lymphatic drainage impairment, the cyst can abruptly grow in size [ 12 ].…”

Embryology of the Abdominal Wall and Associated Malformations—A Review

“…Notably, the GT is not connected to the gonads at any time during embryogenesis. At the end of this period the vaginal process appears, an protrusion and evagination of the peritoneum that surrounds the pelvic and inguinal portion of the GT ( 144 ). The GT and the processus vaginalis herniate together through the abdominal wall accompanied by the transversalis fascia and the internal and external oblique abdominal muscles.…”

“…However PVVs do not represent pathology on their own and may remain asymptomatic and may disappear with increasing growth ( 179 ). Although the processus vaginalis may occur prenatally studies have evaluated an incidence for PPVs in children of about 60% at the age of seven months ( 144 , 180 , 181 ). Presence of a PPV implies a four times higher risk of developing an inguinal hernia within 5.3 years ( 182 ).…”