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| Discussion |
A 38-year-old man presented with complaints of gradually increasing
swelling in the lower abdomen associated with dull aching pain since one
year. He gave history of left scrotal swelling since the past ten years.
Physical examination revealed a palpable lump in the hypogastrium (Fig 1)
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Fig.
1
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RADIOLOGICAL FINDINGS:
Ultrasonography revealed an anechoic collection in the lower abdomen extending
into the right tunica vaginalis. Also noted were right sided hydronephrosis
and hydroureter.( Figs. 2, 3, 4, 5 & 6 )
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Fig.
2
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Fig.
3
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Fig.
4
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Fig.
5
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Fig.
6
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A
CT scan of the abdomen revealed a large cystic collection [10-15 HU] measuring
21 x 15 x 18 cm - extending from the scrotal sac into the abdomen. The right
testis was seen posterior to the collection in the scrotum.
The right kidney showed hydronephrosis and the upper ureter was dilated.
(Figs. 7, 8, 9,10,11&12 )
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Fig.7
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Fig.8
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Fig.9
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Fig.10
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Fig.11
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Fig.12
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Patient refused surgery.
DISCUSSION:
Abdominoscrotal hydrocele is a very rare condition - distinct from the majority
of cases of hydroceles - and is related to the persistence of the processus
vaginalis. The anomaly consists of a large scrotal hydrocele that communicates
in an hourglass fashion with a large abdominal component through the inguinal
canal.
The exact mechanism by which this develops is unknown. It occurs probably due
to progressive involvement and distension of the patient processus vaginalis,
which is cut off from the general peritoneal cavity. Complications sometimes
occur due to pressure on adjacent structures (ureters, iliac vessels).
The diagnosis can be suspected on clinical examination if an abdominal mass
in a lower quadrant is palpable just above the inguinoscrotal pouch.
The diagnosis is confirmed on ultrasonography. Associated testicular dysmorphism
has been reported in some patients.
In any case, as spontaneous resolution of abdominoscrotal hydrocele has never
been reported, surgical treatment is indicated in the form of complete resection
of the tunica vaginalis with ligation of the peritoneal cavity.