Letter to the editor regarding patency of processus vaginalis in abdominoscrotal hydrocele

Abstract

We read with great interest the article by Dr Jose Luis Cuervo et al [1] entitled “Abdominoscrotal hydrocele: its particular characteristics.” A few years ago we reported [2] one of the largest series of abdominoscrotal hydrocele (ASH), and we, too, emphasized the difficulty of treatment of this poorly understood pathologic condition. Although we agree with Cuervo and his associates that “ASH is a condition that begins as a large scrotal hydrocele during the neonatal period and later expands, first, into the inguinal canal and, finally, into the abdominal cavity during the next few months of life,” we disagree with the conclusion that “the ASH is a noncommunicating hydrocele.” Although it is practically impossible to find the opening of the processus vaginalis during the operative procedure, there are two reasons we believe it might in fact remain patent in ASH. First, we observed in our cases that the processus vaginalis (PV) runs parallel to the ASH within the widely dilated inguinal canal. Second, ASH rarely resolves spontaneously, suggesting that the liquid is continuously replenished from the abdominal cavity. So, although there is no direct confirmation that the PV remains patent, we recommend surgical ligation. The most important point, however, is not whether the PV is patent but that the incidence of ASH is probably higher than reported in the literature. It is important to bear in mind during routine surgical correction that a hydrocele may be abdominoscrotal. If an ASH is unsuspected and goes unrecognized, it can be the cause of recurrent scrotal hydrocele when the abdominoscrotal communication but not the PV is ligated and insufficient resection of the tunica vaginalis is performed.