Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 66, Num. 6, 2004, pp. 370-370

Indian Journal of Surgery, Vol. 66, No. 6, November-December, 2004, pp. 370

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Giant abdominoscrotal hydrocele

Agarwal Pawan, Saxena A, Sharma Dhananjaya

Department of Surgery, N.S.C.B. Government Medical College, Jabalpur - 482 003
Correspondence Address:292/293, Napier town, Jabalpur - 482001, (M.P.), drpawanagarwal@yahoo.com

Code Number: is04096

Abdominoscrotal hydrocele (ASH) is a very rare condition. The anomaly consists of a large scrotal hydrocele, which communicates, in an hourglass fashion with a large abdominal component through the inguinal canal.[1] The diagnosis can be suspected on clinical examination if an abdominal mass in a lower quadrant is palpable just above the inguinal ligament in combination with a vaginal hydrocele. Positive cross-fluctuation test confirms the diagnosis.

A 45-year-old male presented with right-sided large scrotal hydrocele and a mass in the right iliac fossa. An exploratory laparotomy through lower midline incision revealed an extra-peritoneal cystic mass extending into the right inguinoscrotal region. [Figure - 1]. The dumbbell shaped mass was excised and the distorted floor of the inguinal canal was repaired. The postoperative period was uneventful. Three months postoperatively an abdominopelvic ultrasound showed no abnormal findings.

Most commonly, ASH presents as a simple abdominoscrotal mass. Sometimes it may present as hydroureter/hydronephrosis or as unilateral leg oedema due to pressure of the mass on the ureter or iliac vein.[2] It may also present with acute abdominal symptoms due to the partial torsion in the abdominoscrotal hydrocele. Rarely, it may present as mesothelioma due to neoplastic changes in the mesothelial lining. The investigation of choice for the diagnosis of ASH is ultrasound. The exact mechanism explaining the phenomenon of ASH is not clear. The most acceptable explanation is the increased pressure in the scrotal area, which pushes the proximal end of the hydrocele sac intra-abdominally. As spontaneous resolution of ASH never occurs, surgical excision is necessary.

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