Congenital Hydrocele

Pediatric surgery

Clinicals - History

Fact Explanation
Scrotal swelling Often a unilateral, tense swelling that is present at birth. There are two types of congenital hydrocele; in the funicular variety; the processus vaginalis remains patent, allowing for communication with the peritoneal cavity. In the encysted variety there is no communication with the peritoneum or tunica vaginalis, and is also known as an encysted cord of the cyst. Right sided hydroceles are relatively more common occurring in 60 percent, left sided hydroceles are rarer at 25 percent while bilateral hydroceles are seen in 15 percent. ,, Scrotal swelling
Often a unilateral, tense swelling that is present at birth. There are two types of congenital hydrocele; in the funicular variety; the processus vaginalis remains patent, allowing for communication with the peritoneal cavity. In the encysted variety there is no communication with the peritoneum or tunica vaginalis, and is also known as an encysted cord of the cyst. Right sided hydroceles are relatively more common occurring in 60 percent, left sided hydroceles are rarer at 25 percent while bilateral hydroceles are seen in 15 percent. ,,
Pain Is a rare occurrence. Severe pain, irritability and tugging at the scrotum indicate the rare possibility of an infected hydrocele. Other causes for an acute scrotum such as torsion and epididymo-orchitis may coexist. , Pain
Is a rare occurrence. Severe pain, irritability and tugging at the scrotum indicate the rare possibility of an infected hydrocele. Other causes for an acute scrotum such as torsion and epididymo-orchitis may coexist. ,
Prematurity Incidence in new born babies is 5%, but it is encountered more often in premature neonates, born before the gestational age (32 to 38 weeks) at which the processus vaginalis closes. The incidence of congenital hydrocele rises with decreasing age of gestation. Prematurity
Incidence in new born babies is 5%, but it is encountered more often in premature neonates, born before the gestational age (32 to 38 weeks) at which the processus vaginalis closes. The incidence of congenital hydrocele rises with decreasing age of gestation.
Congenital hydrocele of the female Known as the hydrocele of canal of Nuck and is rarely reported in children. Often presents later in life as it is not obvious at birth, as a lump in the groin. The diagnosis requires radiological investigation. Congenital hydrocele of the female
Known as the hydrocele of canal of Nuck and is rarely reported in children. Often presents later in life as it is not obvious at birth, as a lump in the groin. The diagnosis requires radiological investigation.

Clinicals - Examination

Fact Explanation
Unilateral scrotal swelling On inspection the swelling fills one side of the scrotum. Though rarely hydroceles can be bilateral. Usually hydroceles are of a ovoid shape, containing up to 500 ml of fluid and can grow to a diameter of 10 cm. , Unilateral scrotal swelling
On inspection the swelling fills one side of the scrotum. Though rarely hydroceles can be bilateral. Usually hydroceles are of a ovoid shape, containing up to 500 ml of fluid and can grow to a diameter of 10 cm. ,
Can palpate the spermatic cord It is possible to 'get above' the lump and palpate the spermatic cord, which confirms that the swelling is confined to the scrotum. Can palpate the spermatic cord
It is possible to 'get above' the lump and palpate the spermatic cord, which confirms that the swelling is confined to the scrotum.
Testis cannot be palpated The testis cannot be palpated separately within the scrotum on the affected side. As the fluid of the hydrocele surrounds the body of the testis. In an encysted hydrocele of the cord, the swelling may extend up to the external ring and moves on tugging of the testis. Testis cannot be palpated
The testis cannot be palpated separately within the scrotum on the affected side. As the fluid of the hydrocele surrounds the body of the testis. In an encysted hydrocele of the cord, the swelling may extend up to the external ring and moves on tugging of the testis.
Smooth, well defined surface The surface of the scrotum is smooth and well defined, rarely it may be possible to palpate a fluctuant lump that is herniation of the hydrocele through its coverings. Smooth, well defined surface
The surface of the scrotum is smooth and well defined, rarely it may be possible to palpate a fluctuant lump that is herniation of the hydrocele through its coverings.
Fluctuant The two layers of the tunica vaginalis are filled in with clear, yellowish fluid that is rich in protein. , Fluctuant
The two layers of the tunica vaginalis are filled in with clear, yellowish fluid that is rich in protein. ,
Transilluminable The fluid contained with the two layers of the tunica vaginalis is transilluminable. , Transilluminable
The fluid contained with the two layers of the tunica vaginalis is transilluminable. ,
Presence of an associated inguinal hernia Often found in association with a congenital hydrocele, due to the patent processus vaginalis, that allows for herniation. , Presence of an associated inguinal hernia
Often found in association with a congenital hydrocele, due to the patent processus vaginalis, that allows for herniation. ,
Undescended testis May co-exist with congenital hydrocele.The patent processus vaginalis generally obliterates upon testicular migration to the scrotum. , Undescended testis
May co-exist with congenital hydrocele.The patent processus vaginalis generally obliterates upon testicular migration to the scrotum. ,

Investigations - Diagnosis

Fact Explanation
Ultrasonography Will show a tubular cystic lesion in the corresponding groin. An abnormal collection of fluid seen in tunica vaginalis between the visceral and parietal layers of the . An ultrasound scan will also demonstrate causes for a secondary hydrocele such as trauma or torsion. Ultrasonography
Will show a tubular cystic lesion in the corresponding groin. An abnormal collection of fluid seen in tunica vaginalis between the visceral and parietal layers of the . An ultrasound scan will also demonstrate causes for a secondary hydrocele such as trauma or torsion.
Pre natal ultrasound scan At 28 weeks of gestation, the testes
begin their descent into the scrotum, posterior to the peritoneum and the processus vaginalis, following the path of the gubernaculum testis. The migration through the inguinal canal takes 2 to 3 days, and the descent from the external ring to the bottom of the scrotum takes an additional 4 weeks. Thus, the process is completed at 32 weeks’ gestation. However, due to the wide variation in this time frame, prenatal scans are only of limited benefit.
Pre natal ultrasound scan
At 28 weeks of gestation, the testes
begin their descent into the scrotum, posterior to the peritoneum and the processus vaginalis, following the path of the gubernaculum testis. The migration through the inguinal canal takes 2 to 3 days, and the descent from the external ring to the bottom of the scrotum takes an additional 4 weeks. Thus, the process is completed at 32 weeks’ gestation. However, due to the wide variation in this time frame, prenatal scans are only of limited benefit.

Investigations - Management

Fact Explanation
Neonatal examination Neonatal examination should be performed in all neonates prior to discharge from a healthcare facility or by a public health worker providing domiciliary care. This will enable identification of scrotal/groin lump and early referral to a surgical unit. Neonatal examination
Neonatal examination should be performed in all neonates prior to discharge from a healthcare facility or by a public health worker providing domiciliary care. This will enable identification of scrotal/groin lump and early referral to a surgical unit.

Management - Specific

Fact Explanation
Conservative The recommended management of a hydrocele is observation during the first 2 years of a child’s life, unless the diagnosis of a hernia cannot be excluded. Most congenital hydroceles due to a patent processus vaginalis resolve before this age. By adopting a wait and see policy it is possible to reduce unnecessary surgery. Conservative
The recommended management of a hydrocele is observation during the first 2 years of a child’s life, unless the diagnosis of a hernia cannot be excluded. Most congenital hydroceles due to a patent processus vaginalis resolve before this age. By adopting a wait and see policy it is possible to reduce unnecessary surgery.
Open surgery Hydroceles that persist or appear beyond the age of 2 years are unlikely to resolve spontaneously and should, therefore, undergo elective surgical repair. At the same time the surgeon should search for a hernial that may not have been clinically evident. , Open surgery
Hydroceles that persist or appear beyond the age of 2 years are unlikely to resolve spontaneously and should, therefore, undergo elective surgical repair. At the same time the surgeon should search for a hernial that may not have been clinically evident. ,
Laparoscopic extra peritoneal repair of hydrocele A two-port laparoscopic technique for treatment of hydrocele in children, which allows a completely extra peritoneal closure of the patent processus vaginalis. Laparoscopic extra peritoneal repair of hydrocele
A two-port laparoscopic technique for treatment of hydrocele in children, which allows a completely extra peritoneal closure of the patent processus vaginalis.

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