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Answer: Abdominoscrotal Hydrocele
The operation was performed through the inguinoscrotal route. The sac was seen extending from the scrotum to the preperitoneal space in the abdomen via the inguinal canal. The fluid was drained through the scrotal component. The sac was completely dissected and excised, including the preperitoneal component. The right testis appeared normal. It could be easily brought down into the scrotum and was fixed in the subdartos pouch. The patient recovered well and was discharged from the hospital on the second day after the operation.
Abdominoscrotal hydrocele is an uncommon condition, more often seen in the pediatric age group. It is characterized by a large scrotal hydrocele that communicates in an hourglass fashion with an abdominal component through the inguinal canal. It is thought to begin as a scrotal hydrocele that later expands into the inguinal canal and the abdominal cavity.1,2
Patients with abdominoscrotal hydrocele usually present with a painless, long-standing, abdominoscrotal mass. This mass can undergo torsion and may present as an acute abdomen or may cause compression of locoregional structures leading to leg edema, hydroureter, hydronephrosis, and/or testicular dysmorphism. This diagnosis should be kept in mind when a cystic, lower abdominal mass is associated with an ipsilateral scrotal hydrocele. Surgical treatment is recommended.3-5
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Correspondence: Tarun Jindal, MS, All India Institute of Medical Sciences, Rm 5010C, Academic Block, New Delhi 110029, India (firstname.lastname@example.org).
Accepted for Publication: February 22, 2010.
Author Contributions:Study concept and design: Sharma. Acquisition of data: Jindal. Drafting of the manuscript: Jindal and Sharma. Study supervision: Jindal.
Financial Disclosure: None reported.
The Editor welcomes contributions to the Image of the Month. Manuscripts should be submitted via our online manuscript submission and review system (http://manuscripts.archsurg.com). Articles and photographs accepted will bear the contributor's name. Manuscript criteria and information are per the Instructions for Authors for Archives of Surgery (http://archsurg.ama-assn.org/misc/ifora.dtl). No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.
Image of the Month—Diagnosis. Arch Surg. 2011;146(6):758. doi:10.1001/archsurg.2011.137-b
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