Abdominoscrotal hydrocele

Abdominoscrotal Hydrocele By Pedro L. Burgues, Jose A. Alvarez, Luis Hernandez, and Juan L. Teixidor Oviedo, Spain 9 Abdominoscrotal hydrocele is a very rare finding, especially in infants. The authors describe the case of a 7-month-old boy presenting an abdominoscrotal mass, the diagnosis of which was made by sonography and which was excised totally through an extensive inguinal incision. 9 1986 by Grune & Stratton. Inc. INDEX W O R D S : Hydrocele; abdominoscrotal abdominal mass.

hydrocele;

B D O M I N O S C R O T A L hydrocele was first described by Dupuytren in 1834 ~ as "hydrocele in bisac." In the world literature there are only seven cases of this condition mentioned in children under 1 year of age. Abdominoscrotal hydrocele must be taken into consideration for differential diagnosis in abdominal masses at this age. z

A

CASE REPORT A 7-month-old boy was admitted to our hospital with a tense scrotal mass on the left side, which had been present since the second month of life without varying in size or causing any pain or other problems. Physical examination revealed a left funiculotestical hydrocele and an abdominal mass in the left lower quadrant and hypogastrium of about 10 • 7 cm, neither painful nor mobile, which increased in size when squeezing the testical hydrocele, as well as the tension of the hydrocele increased on palpation of the abdominal mass. Abdominal roentgenogram showed a mass in the left lower quadrant pushing the sigmoid colon medially. Sonography showed a cystic mass in the left scrotum, which extended through the internal inguinal ring into the retroperitoneum. The part of the mass in the

Fig 2.

Hydrocele exteriorized through the incision.

abdominal cavity had a size of about 6 • 4 cm (Fig 1). Both kidneys were normal, showing no signs of hydronephrosis. Cystographic examination revealed a displacement of the bladder towards the median line. The child was operated upon for abdominoscrotal hydrocele, performing an extensive inguinal incision on the left side, dissecting first the funiculotestical part of the bydrocele, continuing through the internal inguinal ring in order to visualize the whole cystic mass (Fig 2). Total excision could thus be accomplished. Left orchidopexy was performed, as well as reconstruction of the inguinal canal. There were no postoperative complications.

DISCUSSION

An abdominoscrotal hydrocele is a collection of fluid in the tunica vaginalis extending through the inguinal canal into the abdominal cavity. 3

Fig 1. Sonography showing the abdominal and scrotal portions of hydrocele communicated between them.

Journal of Pediatric Surgery, Vol 21, No 11 (November), 1986: pp 987-988

From the Departments of Paediatric Surgery and Radiology, Hospital Ntr Sra of Covadonga, Oviedo, Spain. Address reprint requests to Pedro L. Burgubs, Department of Paediatric Surgery, Hospital Ntr Sra of Covadonga, Celestino Villamil sin 33006, Oviedo, Spain. 9 1986 by Grune & Stratton, Inc. 0022-3468/86/2111-0031503.00/0

987

988

Its evolution is t h a t of a funiculotestical hydrocele that extends into the retroperitoneal space t h r o u g h the internal inguinal ring, due to progressive increase of pressure. 4 A c c o r d i n g to the classification of a b d o m i n o s c r o t a l hydrocele m a d e by P a r e k h et al, 5 our case corresponds to the complete and indirect type, the s a m e as t h a t described by G o n z a l e z et al. 6 Usually, it is discovered by a b d o m i n a l palpation in a child with scrotal hydrocele. T h e r e is an a b d o m i n a l mass of variable size and firm consistence, c h a r a c t e r i s tically with an increase of tension within the hydrocele when squeezing the a b d o m i n a l mass, as well as an increase of the a b d o m i n a l mass when pressing the scrotal portion of the hydrocele. 7 The diagnosis is based on sonography, which shows a cavity filled with fluid and without c o m p a r t m e n t s , with well-defined limits of the a b d o m i n a l and the scrotal portion. A t the s a m e time it rules out compression of a d j a c e n t organs. A case of hydronephrosis has been described due to u r e t e r a l compression by the hydrocele. 8 A f t e r a correct p r e o p e r a t i v e diagnosis, the r e p a i r of an a b d o m i n o s c r o t a l hydrocele consists in the total

BURGUES ET AL

excision of the mass t h r o u g h an extensive inguinal incision 9 with further reconstruction of the inguinal canal. REFERENCES

1. Dupuytren G: Lecons orales de clinique chirurgicale. G Balliere 4:705, 1834 2. Casolari E, Cacciari A, Federici S: Abdominoscrotal hydrocele in childhood. Case report and review of the literature. Z Kinderchir 38:353-355, 1983 3. Ahmed S: Abdominoscrotal hydrocele in an infant. Surgery 70:316-317, 1971 4. Brothers LR, Feldtman RW: Abdominoscrotal hydrocele: Youngest case report and review of the literature. J Urol 126:847848, 1981 5. Parekh BR, Reinboth G, Mishra OP: Abdominoscrotal hydrocele. Br J Surg 62:629-632, 1975 6. Gonzalez N, Esteban JA, Romeo M, et al: Hidrocele abdomino escrotal. Aportaci6n de un caso nuevo. An Esp Pediatr 18:310-313, 1983 7. Black RE, Cox JA, Han B, et al: Abdominoscrotal hydrocele. Cause of abdominal mass in children. Pediatrics 67:420-423, 1981 8. Firfer R, Berkson BM, Lipshitz S: Abdominoscrotal hydrocele in infant with hydronephrosis. J Urol 122:426-427, 1979 9. Saharia PC, Bronsther B, Abrams MV: Abdominoscrotal hydroele. Case presentation and review of the literature. J Pediatr Surg 14:713 714, 1979