Congenital hydrocoele

A congenital hydrocoele is a primary hydrocoele that communicates with the peritoneal cavity through a narrow orifice (patency of the processus vaginalis). Rarely, there may be an associated hernia.

A hydrocoele is formed if the patent processus is only a small opening. In this case only fluid from the peritoneal cavity will pass down the processus. This causes the hydrocoele.

The typical hydrocele is observed at or shortly after birth as a unilateral or bilateral swelling in the scrotum, which may fluctuate in size.

The scrotum appears enlarged with fluid; it may be very tense, is usually nontender and is, often, bluish in colour. The inguinal canal is normal.

The fluid in the hydrocoele disappears into the abdominal cavity when the patient is supine, for example at night, and returns when the patient is erect. It cannot be emptied by digital pressure as this causes an inverted "ink bottle" effect at the internal ring.

If the proximal opening of the processus is wide then a true inguinal hernia is formed.

Managment of infant hydrocele:

• idiopathic hydrocele is a common reason for referral to the paediatric surgery outpatient clinic and nearly 3000 operations for hydrocele are performed by surgeons each year in England (1)
• recommended management of a hydrocele is observation during the first one to two years of a child' life, unless the diagnosis of a hernia cannot be excluded
  • the International Pediatric Endosurgery Group states that most surgeons advocate observation before 12 months of age and that the majority of patent processus vaginalis’ (PPVs) will close within the first 12–24 months of life; they do not provide a specific recommendation for the age at which surgery should occur( 2)
  • in the UK, the most frequent age at which surgery takes place is between 24 and 36 months (1)
  • hydroceles that persist or appear beyond two years of age are unlikely to resolve spontaneously and should, therefore, undergo elective surgical repair (3)

Reference:

• Jobson M, Hall NJ. Current practice regarding timing of patent processus vaginalis ligation for idiopathic hydrocele in young boys: a survey of UK surgeons. Pediatr Surg Int. 2017; 33(6): 677–681.
• Group IPE (2010) IPEG Guidelines for Inguinal Hernia and Hydrocele. J Laparoendosc Adv Surg Tech A 20(2):x–xiv. doi:10.1089/lap.2010.999
• Inguinal hernias and hydroceles in infancy and childhood: A consensus statement of the Canadian Association of Paediatric Surgeons. Paediatr Child Health. 2000 Nov-Dec; 5(8): 461–462