Abdominoscrotal Hydrocele: An Uncommon Cause of Abdominoscrotal Cystic Swelling

Abstract

Abdominoscrotal hydrocele (ASH) consists of fluid-filled intercommunicating inguinoscrotal and abdominal sac with a characteristic hourglass-like picture on CECT, which usually affects single testis and a rare cause of abdominoscrotal cystic swelling. The precise etiology of ASH is not known. Ultrasonography is the initial diagnostic modality of choice as it demonstrates the intercommunication between the two sacs and also identifies any abnormality of the testis and genitourinary tract. We are reporting a case of a 27-year-old patient presented in the General Surgery OPD of Acharya Vinoba Bhave Hospital in 2019 with bilateral scrotal and abdominal swelling. On examination, cross fluctuation was positive between left hydrocele and abdominal swelling, raising suspicion of ASH, which was confirmed on CECT. The patient underwent excision of sac through left inguinoscrotal approach and an uneventful postoperative course.

A Review of Classification, Diagnosis, and Management of Hydrocele

“…CT combined with ultrasound will give more accurate diagnostic results (Figures 6 and 7). 12,13 Magnetic Resonance Imaging Some disadvantages of magnetic resonance imaging (MRI) are high cost, slow scanning speed, and requires anesthesia in young children. It is rarely indicated for the evaluation of hydroceles, and is often used for complicated cases that require further investigation when ultrasound or CT is unclear.…”

“…Treatment with aspiration and sclerotherapy of the cyst can be done, or surgical removal of the cyst with isolation of the neck of the cyst and dissection of the entire cyst is also recommended. [10][11][12][13][14][15][16] -16 Note that if the processus vaginalis is not ligation, it can lead to postoperative fluid collection (Figure 9). This collection can be regressed or persistent.…”

“…Hydrocele type 7 presents as an encysted spermatic cord hydrocele or encysted hydrocele of the canal of Nuck. Treatment with aspiration and sclerotherapy of the cyst can be done, or surgical removal of the cyst with isolation of the neck of the cyst and dissection of the entire cyst is also recommended 10–16 . Note that if the processus vaginalis is not ligation, it can lead to postoperative fluid collection (Figure 9).…”

A case series of adult abdominoscrotal hydrocele: A rare condition

“…1 Eventually, it leads to the formation of two sacs connected by an isthmus resulting in an hourglass or dumbbell-shaped appearance. 2 Sizes of both the sacs vary independently but the abdominal sac is usually larger than the scrotal sac. [3][4][5] It is a two-compartment cystic lesion that may or may not communicate with each other.…”