This document discusses hydroceles, which are abnormal collections of serous fluid in the processus vaginalis of the scrotum. There are congenital and acquired types. Congenital hydroceles occur when the processus vaginalis remains patent, while acquired hydroceles develop secondary to conditions like epididymo-orchitis or testicular tumors. Hydroceles are usually painless swellings that surround the testis and epididymis, making them difficult to palpate. Treatment involves surgical excision of the hydrocele sac. Complications can arise if hydroceles are not treated, such as rupture or testicular atrophy.

1. Presented by- IBRAHIM KABIR

2. It is an abnormal collection of serous fluid in a part of the processus
vaginalis, usually the tunica vaginalis.

3. CONGENITAL
 Vaginal Hydrocele- occurs in the space between the two layers of
tunica vaginalis. It is the most common variety and the swelling is
usually painless.
 Infantile hydrocele- processus vaginalis is occluded at the deep inguinal
ring.
 Congenital hydrocele- processus vaginalis is patent and connects with
the general peritoneal cavity.
 Encysted hydrocele of the cord- smooth oval swelling associated with
spermatic cord.

5. Acquired
 Primary/Idiopathic- cause is unknown
 Secondary- secondary to the disease of testis and
epididymis.
• Acute or chronic epididymo-orchitis
• Torsion of the testis
• Testicular tumor
• Haematocele

6.  By excessive production of fluid within the sac.
 By defective absorption of fluid.
 By interference with lymphatic drainage of scrotal structures.
 By connection with the peritoneal cavity via a patent processus
vaginalis (congenital).

7.  Hydroceles are typically translucent and it is possible to ‘get
above the swelling’ on examination of the scrotum. The swelling
usually surrounds the testis and epididymis such that they
may become impossible to palpate separately.
 A primary vaginal hydrocele is seen most commonly in
middle and later life but can also occur in older children. The
condition is particularly common in hot countries. Because the
swelling is usually painless it may reach a prodigious size before
the patient presents for treatment. The testis may be palpable
within a lax hydrocele, but an ultrasound scan is necessary to
visualise the testis if the hydrocele sac is tense.

8.  In congenital hydrocele, the processus vaginalis is patent and
connects with the peritoneal cavity. The communication is usually too
small to allow herniation of intra-abdominal contents.
Pressure on the hydrocele does not always empty it but the
hydrocele fluid may drain into the peritoneal cavity when the
child is lying down; thus, the hydrocele may be intermittent.
Ascites should be considered if the swellings are bilateral
 Encysted hydrocele of the cord is a smooth oval swelling near
the spermatic cord, which is liable to be mistaken for an inguinal
hernia. The swelling moves downwards and becomes less mobile
if the testis is pulled gently downwards.

9.  VAGINAL HYDROCELE
 Lord’s operation: when the sac is reasonably thin walled
 Jaboulay’s procedure: eversion of the sac with placement of the testis
in a pouch prepared by blunt dissection in the fascial planes of the
scrotum.
 INFANTILE HYDROCELE: thin sac should be excised.
 CONGENITAL HYDROCELE: treated by herniotomy if they do not resolve
spontaneously.
 ENCYSTED HYDROCELE OF THE CORD: excision of the cyst.
 SECONDARY HYDROCELE: treatment according to the cause.

10. I. Rupture
II. Haematocele due to spontaneous bleeding into the sac or as result of
trauma
III. Herniation of the hydrocele sac through the dartos muscle
IV. Atrophy of the testis in long standing cases

11. TRAITS INGUINAL HERNIA HYDROCELE
DEFINITION Bulging of part of the contents of the
abdominal cavity throygh a weakness in
the abdominal wall
Abnormal collection of serous fluid in a
part of the processus vaginalis, usually the
tunica vaginalis
SITE Inguinoscrotal Scrotal
Get above the swelling Not Possible Possible
Reducibility Present Absent
Transillumination test Negative Positive
Consistency Variable Cystic