Bilateral Patent Processus Vaginalis with Chylous Effusion in a Pediatric Patient: A Rare Case Report and Literature Review

Abstract

Background Chylous effusion is a rare condition characterized by the accumulation of lymphatic fluid in body cavities, often due to trauma, malignancy, or congenital lymphatic abnormalities. The association of chylous effusion with a patent processus vaginalis (PV) in pediatric patients is exceptionally uncommon, presenting unique diagnostic and therapeutic challenges. Objective To report a rare case of bilateral patent processus vaginalis with chylous effusion in a pediatric patient, detailing the diagnostic process, surgical management, and outcomes, while contributing to the limited literature on this condition. Methods A 1-year-10-month-old male presented with a left inguinal-scrotal swelling. Ultrasonography suggested a hydrocele. Laparoscopic exploration revealed bilateral patent PVs with chylous fluid in the abdominal cavity and tunica vaginalis. The fluid was aspirated and analyzed, confirming chylous effusion. Bilateral high ligation of the PV was performed, and the patient was initially managed with a specialized diet. Results The patient underwent successful laparoscopic bilateral high ligation of the PVs with complete resolution of symptoms. Follow-up ultrasonography at one week, one month, and three months post-surgery showed no evidence of fluid accumulation or hydrocele recurrence. Conclusion Bilateral patent processus vaginalis with chylous effusion is an extremely rare condition in pediatric patients. This case demonstrates that early surgical intervention with laparoscopic high ligation can effectively resolve the condition without the need for prolonged dietary modifications. Further documentation of similar cases is necessary to better understand and manage this rare clinical presentation.