Laparoscopic treatment of an abdominoscrotal hydrocele: A case report

Abstract

Introduction Abdominoscrotal hydrocele (ASH), a composite of scrotal and abdominal hydroceles connected through the inguinal canal, is rare and no consensus regarding its mechanisms and surgical treatments has been reached to date. Presentation of the case We report a case of an 11-month-old boy with a large ASH. Ultrasonography and magnetic resonance imaging (MRI) revealed a huge hydrocele (maximum length: 8 cm). The patient underwent laparoscopic percutaneous extraperitoneal closure (LPEC) and the orifice of the processus vaginalis (PV) was completely closed. The postoperative course was uneventful. Follow-up ultrasonography and MRI in the first postoperative year showed no recurrence of ASH. Discussion An ASH with a length >8 cm is considered rare in pediatric patients. There is no consensus regarding its etiology and surgical intervention is selected according to the patient's condition and the characteristics of ASH. We opted to perform early surgical intervention considering the ASH size and the adverse effects on testicular development. LPEC helped identify the condition and location of the ASH and allowed safe and reliable operation of the large intrapelvic hydrocele. In patients with no PV patency, a change in approach from LPEC to an open anterior approach should be considered even if LPEC is feasible. Conclusion This case provides valuable insight into successful LPEC of a large ASH without any complications, highlighting the importance of elucidating the morphological mechanisms and making an accurate diagnosis and the challenges associated with these processes.

Abdominoscrotal Hydrocele: A Systematic Review

“…Hosoda, et al (2021) 7 made the decision to undergo early surgical surgery taking into consideration the size of the ASH and the negative implications on the development of the testicles. In addition to assisting in the identification of the status and position of the ASH, LPEC made it possible to operate the big intrapelvic hydrocele in a secure and dependable manner.…”

“…The LPEC assisted in determining the location and condition of the ASH and enabled the large intrapelvic hydrocele to be operated upon in a secure and dependable manner. 7,10 LPEC is a safe and effective surgical procedure for individuals afflicted with ASH. Nevertheless, a technical issue persists in which confirmation of an internal inguinal ring is impeded when it is obscured by a distended hydrocele that protrudes from the abdominal cavity.…”

“…Nevertheless, a technical issue persists in which confirmation of an internal inguinal ring is impeded when it is obscured by a distended hydrocele that protrudes from the abdominal cavity. 7,10 To detect the internal inguinal ring, an ultrasound-guided incision from the scrotum or inguinal region to the hydrocele may be performed in such instances. However, in cases where the ultrasound-guided puncture proves inadequate, laparoscopic puncture via dissector or needle may be employed.…”