Communicating Hydrocele in a Six-Year-Old

A 6-year-old boy presented with a mass on the left side of the scrotum (A). The mass did not vary in size and was asymptomatic; it transilluminated brightly. Physical examination showed it to be 4 × 2 cm. The spermatic cord could be felt above the mass. The left testis was impalpable separately.

This child had a noncommunicating hydrocele, a mass that results from excessive accumulation of fluid in the tunica vaginalis as a consequence of obliteration of the processus vaginalis proximally with patency distally. The lesion is benign and self-limited. Hydroceles are often bilateral (B). Most disappear by the end of the first year of life; those that do not should be repaired surgically.

A communicating hydrocele results from patency of the processus vaginalis. It has the same origin as an indirect inguinal hernia except that peritoneal fluid leaves the peritoneal cavity instead of bowel. The size of a communicating hydrocele fluctuates; it is smaller when the patient is recumbent. The condition is more common when there is increased intra-abdominal pressure. A communicating hydrocele is treated as an indirect inguinal hernia.