This document describes a case report of a congenital vaginal hydrocele in a 4-year old boy. A hydrocele is a collection of fluid within the tunica vaginalis that often presents as an enlarged scrotum in infants. This boy had swelling of the right scrotum since birth. Examination confirmed a right-sided hydrocele. Ultrasound also showed fluid in the right scrotum. The hydrocele was diagnosed as congenital and communicating. It was surgically corrected through a hydrocelectomy procedure to drain the fluid and evert and stitch the tunica vaginalis. Complications can include infection, blood clots, or recurrence of the hydrocele. Most hydroce

1. ANTHONY GABRIAL.S
Indira Gandhi Medical College & Research Institute
Pondicherry
CONGENITAL
VAGINAL
HYDROCELE
A case report

2. INTRODUCTION
 Definition: 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.

3.  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.

4. MATERIALS & METHODS
 A 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.

5. HYDROCELE

6. ON EXAMINATION
 Skin and subcutaneous tissue: Tense,
normal rugosity of the skin lost.
 Impulse on coughing: Negative
 Fluctuation: Positive
 Transillumination test: Positive
 Reducibility: Positive.
 Testis- can be palpated posteriorly
 Lymph nodes- Not palpable
 Left scrotum was normal.
 USG : Done for right scrotum

7. ULTRASONOGRAPHY
USG reveals the right testicle with
hydrocele

8.  On examination, It was identified as
COMMUNICATING HYDROCELE.
 It was diagnosed as CONGENITAL RIGHT
SIDED VAGINAL HYDROCELE & surgical
correction of the hydrocele was done.

9. DISCUSSION
CONGENITAL VAGINAL HYDROCELE
Fluid-filled sac surrounding a testicle
swelling of the scrotum
Presented as loose bag of skin underneath
the penis.

10.  As the testes
descends it carries along
with it a double layered
Peritoneal sac –
PROCESSUS
VAGINALIS.
 Later on the distal
portion of processus
vaginalis alone persists
as TUNICA VAGINALIS.
 Proximal portion
obliterates.
DEVELOPMENT

11. Descend of Testis

12. TYPES
VAGINAL
HYDROCELE
COMMUNICATING
HYROCELE
INFANTILE
HYDROCELE
HYDROCELE
OF CORD

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

14. INCIDENCE
 30% in the infant boys
◦ (8% - 33%)
 10% in the infant girls
◦ (6% - 15%)
 40% in aldults
◦ (19% - 41%)
 58% - 93% right sided
 <10% left sided
 Few are bilateral

15. SURGICAL TREATMENT
 Mostly resolve with medical treatment.
 If discomfort or very large, two methods of
treatment are available
a) aspiration and
b) hydrocelectomy (surgery).
WITHOUT
SURGERY
ASPIRATION
HYDROLECETO
MY

16. ASPIRATION
 Needle is used to drain the fluid.
 Not common treatment for hydroceles,
but performed when surgery is too
risky.
 Complication: FIBROSIS

17. 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

18. COMPLICATIONS
 Infertility
 Testicular atrophy.
 Haematoma.
Excessive scar formation.
 Recurrence of the hydrocele after inguinal
approaches.

19. CONCLUSION
 Hydrocele 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

20. BIBLIOGRAPHY
 Scrotal swelling : NICE, CKS, Feb 2010.
 Aspiration versus hydrocelectomy for the
treatment of hydroceles.
 Rudkin SE et al, Hydrocele in emergency
medicine
 Clinical hydrocele : A Manual Method Of
Surgeey, S.DAS
 Hydrocele swelling : net source Wikipedia
 Hydrocele overview : Mayo Clinic
 Kogan BA. Communicating hydrocele/hernia
repair in children. BJU Int 2007;100:703-13