ANTHONY GABRIAL.SIndira Gandhi Medical College & Research InstitutePondicherry

CONGENITAL VAGINAL

HYDROCELE

A case report

INTRODUCTIONDefinition: Is a collection of fluid

within the tunica vaginalis of the testis.

Common in newborns.

Most hydroceles disappear without treatment within the 18 months of life.

Usually unilateral, but can also occur bilatarally

Hydrocele normally is seen in infant boys - as enlarged

scrotum. in infant girls - as enlarged

labia.Hydrocele boys > girls. There is a greater chance of

infertility if the hydrocele does not show itself until the child has reached adulthood.

MATERIALS & METHODSA 4 years old boy was referred to the

pediatric OPD with swelling of right scrotum since birth.

The mother complained of swelling of right scrotum, which increased in size gradually.

No h/o pain.There was no h/o decresing in size of

swelling on lying position.No h/o increase in size with swelling

on coughing.

HYDROCELE

ON EXAMINATIONSkin and subcutaneous tissue:

Tense, normal rugosity of the skin lost.

Impulse on coughing: NegativeFluctuation: PositiveTransillumination test: PositiveReducibility: Positive.Testis- can be palpated posteriorlyLymph nodes- Not palpableLeft scrotum was normal.USG : Done for right scrotum

ULTRASONOGRAPHY

USG reveals the right testicle with hydrocele

On examination, It was identified as COMMUNICATING HYDROCELE.

It was diagnosed as CONGENITAL RIGHT SIDED VAGINAL HYDROCELE & surgical correction of the hydrocele was done.

DISCUSSIONCONGENITAL VAGINAL HYDROCELE

Fluid-filled sac surrounding a testicle

swelling of the scrotum

Presented as loose bag of skin underneath the penis.

As the testesdescends it carries alongwith it a double layeredPeritoneal sac – PROCESSUS

VAGINALIS. Later on the distalportion of processusvaginalis alone persistsas TUNICA VAGINALIS.Proximal portionobliterates.

DEVELOPMENT

Descend of Testis

TYPES

VAGINAL HYDROCELE

COMMUNICATING HYROCELE

INFANTILEHYDROCELE

HYDROCELE OF CORD

Congenital vaginal hydrocele results when the processus vaginalis remains patent, allowing fluid from the peritoneum to accumulate in the scrotum.

INCIDENCE30% in the infant boys

◦(8% - 33%)10% in the infant girls

◦(6% - 15%)40% in aldults

◦(19% - 41%)58% - 93% right sided<10% left sidedFew are bilateral

SURGICAL TREATMENTMostly resolve with medical treatment. If discomfort or very large, two methods

of treatment are available a) aspiration and b) hydrocelectomy (surgery).

WITHOUT SURGERY

ASPIRATION

HYDROLE-CETOMY

ASPIRATIONNeedle is used to drain the fluid. Not common treatment for

hydroceles, but performed when surgery is too risky.

Complication: FIBROSIS

Hydrocelectomy Minor surgical procedure where fluid is

drained.Under anesthesia, through a small

incision, fluid is drained and while stitching, the tunica vaginalis is everted and stitched.

Here the proximal part is also cut and stitched.

Complications: blood clot, infection & injury to scrotum

COMPLICATIONSInfertilityTesticular atrophy.Haematoma.Excessive scar formation.Recurrence of the hydrocele after

inguinal approaches.

CONCLUSIONHydrocele is a differential diagnosis in

males commonly presenting with an enlarged scrotum.

Hydroceletomy is done & tunica vaginalis is everted &stitched.

Proximal part extending into inguinal region is also stitched in its proximal portion.

Most commonly seen in boys than girls.Congenital communicating hydrocele is

accompanied with hernia and so a search on hernia with hydrocele should be ruled out.

BIBLIOGRAPHYScrotal swelling : NICE, CKS, Feb 2010.Aspiration versus hydrocelectomy for the

treatment of hydroceles.Rudkin SE et al, Hydrocele in emergency

medicineClinical hydrocele : A Manual Method Of

Surgeey, S.DASHydrocele swelling : net source

WikipediaHydrocele overview : Mayo Clinic Kogan BA. Communicating hydrocele/hernia repair in

children. BJU Int 2007;100:703-13