UNASSIGNED: The aim of the study was to highlight the pathology, clinical spectrum, and approach considerations in abdominoscrotal hydrocele (ASH).
UNASSIGNED: Our study included eight children with ASH from 2015 to 2022. The demographics, clinical presentation, investigations, operative details, and postoperative outcome were collected retrospectively from case files.
UNASSIGNED: The age of presentation ranged from 11 months to 2½ years. Six lesions were on the right side and two were on the left side. One child presented with an acute scrotum and underwent emergency inguinal exploration, revealing hemorrhagic fluid after trauma. Others presented with tense inguinoscrotal swelling, which was fully reducible but refilled promptly after emptying. Preoperative ultrasound showed the abdominal component in 50%, while others were detected intraoperatively. All of them were approached inguinally, and the hydrocele sac was traced proximally to the abdominal component through the internal ring. This was drained and a partial excision of the extraperitoneal sac was done. An additional patent processus vaginalis (PPV) was identified in 87%, dissected up to the deep ring, and ligated. On follow-up, there was no recurrence.
UNASSIGNED: ASH is an uncommon condition that should be identified and dealt with appropriately. Physical examination and ultrasonography are usually sufficient for diagnosis. The inguinal approach is a safe, simple method and an extension of the standard operation for the hydrocele. One must keep in mind to explore for an additional narrow PPV to prevent the recurrence of hydrocele.

Abdominoscrotal hydrocele (ASH) represents a rare condition characterized by abdominoscrotal cystic enlargement that exhibits hourglass-shaped, fluid-filled accumulation communicating with scrotal and abdominal components on contrast-enhanced computed tomography. We present the case of a 44-year-old patient who presented with swelling in the right scrotal and abdominal regions. Upon examination, a positive cross-fluctuation was observed between the right scrotal swelling and the abdominal swelling, raising suspicions of ASH, which was subsequently confirmed radiologically. The patient underwent a right-sided sac excision and sac ligation at the deep ring performed through a right inguinal approach and subsequently experienced a smooth and uncomplicated recovery during the postoperative period. Surgical repair is the most common management approach rather than conservative management, and the use of an inguinal method over other surgical methods facilitates a lower risk of inadvertent injury to adjacent anatomical structures.

Abdominoscrotal hydrocele (ASH) is a rare condition characterized by a large scrotal and abdominal fluid-filled sac. An inguinal surgical approach is generally described in literature. We report the case of a 7-month-old child who underwent surgical repair of bilateral ASH through bilateral transverse scrotal incisions. The scrotal approach enabled optimal visibility and access to the hydrocele sacs. Separation of the sac from the testicular pedicle was possible with excellent control. Complete excision of the sac was performed. The postoperative course was uneventful. Follow-up after three years shows an excellent result. We recommend ASH repair through a transverse scrotal incision.

BACKGROUND: Infantile abdominoscrotal hydrocele is generally managed with early surgery. However, whether these patients actually benefit from an initial watchful waiting strategy is yet to be determined.
METHODS: This single-center, comparative observational analysis included 36 consecutive patients (9 bilateral cases) diagnosed between January 1998 and December 2019. Initial 16 patients (21 lesions) underwent surgical repair shortly after diagnosis (Group A) at a mean (SD) age of 8 (4) months. Remaining 20 patients (24 lesions) underwent initial nonoperative management (Group B). Overall follow-up was 82.74 (63.84) months.
RESULTS: Six lesions of Group B spontaneously regressed at a mean age of 23.8 (7.8) months. Remaining 18 hydroceles underwent surgical management at a mean age of 18.7 (12.6) months. Early postoperative morbidity was high (43%) in both groups (Clavien-Dindo grade I-II). During follow-up, there were 1 recurrent hydrocele and 1 testicular atrophy, both events occurring in Group A patients. Group B patients required a higher need for concomitant ipsilateral orchidopexy (61% versus 14%; p = 0.001), and developed a higher rate of ipsilateral inguinal hernia (39% versus 5%; p = 0.01), occurring within 8.3 (3.53) months of surgery. On multivariable analysis, nonoperative management was associated with unplanned second surgery (odds ratio 5.5, 95% CI 1.25-24.17, p = 0.02), regardless of the type of hydrocelectomy performed.
CONCLUSIONS: Nonoperative management provides effective spontaneous resolution in about 25% of infantile abdominoscrotal hydrocele. Clinicians must balance the potential benefits of such strategy against the impact of pressure induced detrimental effects on the success of future surgery when dealing with longstanding lesions.
METHODS: III.

BACKGROUND: Abdominoscrotal hydrocele (ASH), a composite of scrotal and abdominal hydroceles connected through the inguinal canal, is rare and no consensus regarding its mechanisms and surgical treatments has been reached to date.
METHODS: We report a case of an 11-month-old boy with a large ASH. Ultrasonography and magnetic resonance imaging (MRI) revealed a huge hydrocele (maximum length: 8 cm). The patient underwent laparoscopic percutaneous extraperitoneal closure (LPEC) and the orifice of the processus vaginalis (PV) was completely closed. The postoperative course was uneventful. Follow-up ultrasonography and MRI in the first postoperative year showed no recurrence of ASH.
CONCLUSIONS: An ASH with a length >8 cm is considered rare in pediatric patients. There is no consensus regarding its etiology and surgical intervention is selected according to the patient\'s condition and the characteristics of ASH. We opted to perform early surgical intervention considering the ASH size and the adverse effects on testicular development. LPEC helped identify the condition and location of the ASH and allowed safe and reliable operation of the large intrapelvic hydrocele. In patients with no PV patency, a change in approach from LPEC to an open anterior approach should be considered even if LPEC is feasible.
CONCLUSIONS: This case provides valuable insight into successful LPEC of a large ASH without any complications, highlighting the importance of elucidating the morphological mechanisms and making an accurate diagnosis and the challenges associated with these processes.

Abdominoscrotal hydrocele (ASH) is an uncommon congenital anomaly in which a scrotal hydrocele extends to the abdomen through the inguinal canal in an hourglass fashion. Coexisting undescended testes (UDT) have mainly been reported in pediatric populations and are mostly located along the inguinal canal. We present a 66-year-old male with a history of neglected left cryptorchidism, who presented with a progressive ipsilateral inguino-scrotal swelling suggesting indirect inguinal hernia. On physical examination, inguino-scrotal hydrocele was suspected. Abdomen and pelvis computed tomography scan and magnetic resonance imaging revealed an abdominoscrotal cyst with a pathognomonic dumbbell appearance of an ASH, as well as an intra-abdominal testicle that proved to be intracystic, atrophic, and hypovascular. The patient underwent successful radical en-bloc excision of the ASH and testis via an extended inguinal approach. To our knowledge, this is the first case with this constellation of urogenital abnormalities to be reported in an aged man. What makes this case further unique and interesting is the unusual ASH\'s relationship with the patient\'s cryptorchid testicle and peritoneal sac.

BACKGROUND: Abdominoscrotal hydroceles (ASH) are uncommon occurrences in boys and usually treated similarly to a hernia with the assumption that there is an associated patent processus vaginalis. Treatment in this manner may be challenging due to sac size, extension and adherence to the spermatic cord. Due to the rarity of ASH, the literature is mostly limited to small, single-institution case studies.
OBJECTIVE: Our goal was to evaluate two techniques in large number. We hypothesized a simplified scrotal technique with eversion, Jaboulay procedure, would demonstrate less complications and equivalent efficacy to standard excision.
METHODS: We retrospectively reviewed medical records at three tertiary children\'s hospitals to identify boys who underwent surgical repair of ASH between 1998 and 2018. Group 1 had excision and/or ligation of the hydrocele sac. Group 2 had a scrotal incision with limited excision and then eversion of the hydrocele sac (Jaboulay procedure). Variables that were analyzed included preoperative imaging, surgical technique, surgical findings, length of follow up, complications and recurrence of swelling.
RESULTS: We identified 61 boys, who had 77 abdominoscrotal hydroceles. Group 1 included 38 patients with 48 hydroceles. Group 2 included 23 patients with 29 hydroceles. Complications were more common in Group 1 patients (18% vs 0%) but complication rate and operative time were not statistically associated with surgery type or age. No patient in either group had recurrence of hydrocele.
CONCLUSIONS: Although this is a large study for this rare condition, the analysis is limited by number and its retrospective nature.
CONCLUSIONS: For the rare and difficult to treat abdominoscrotal hydrocele, we were unable to prove with statistical significance that a simplified technique of eversion via the scrotum is safer. However, this large series did demonstrate that the simplified procedure provides equal efficacy as excision.

Abdomino scrotal hydrocele (ASH) is a very rare condition in which the hydrocele sac extends beyond the scrotum to the abdomen via the inguinal canal. Although various ideas have been proposed regarding this disease, there is still controversy over its etiology. We report a case of abdominoscrotal hydrocele in a one year old boy (Mofid Children\'s hospital, Tehran, Iran) with history of right sided herniorrhaphy one month ago in other center. Slow growing mass in lower abdomen was noted by parents. For better diagnose, ultrasound and CT scan was performed. In operation missed large abdominalscrotal hydrocele was confirmed.

BACKGROUND: Abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by a fluid-filled mass with inguinoscrotal and abdominal components. Controversy exists regarding the best management. We conducted a systematic review of the literature with special interest in presentation, management and outcomes.
METHODS: A search was conducted of the MEDLINE/PubMed, Embase, Ovid, Web of Science and Scopus databases. Two authors independently extracted data and assessed the risk of bias in each study.
RESULTS: We found 18 case series that met selection criteria, describing 116 patients with 146 hydroceles. Unilateral ASH was found in 59% of cases with almost even distribution between left and right-sided hydroceles. Ipsilateral undescended testicle, testicular dysmorphism, and contralateral pathology (inguinal hernia) often accompanied ASH. Management was always surgical. The most common approaches were inguinal (67.2%), combined laparoscopic + inguinal (11.2%), and scrotal (10.3%). Complications were poorly reported, but were generally minor. There were a decreased number of complications with the scrotal approach because of avoidance of a difficult inguinal dissection.
CONCLUSIONS: ASH is a rare entity treated most commonly via an inguinal approach. However, consideration should be given to combining with an extraperitoneal or laparoscopic approach given coexisting pathology, or to the scrotal approach for reducing morbidity.

Abdominoscrotal hydrocele (ASH) is an uncommon entity characterized by an hourglass-shaped hydrocele that extends from the scrotum into the abdominal cavity. In this case, ultrasonography and computed tomography findings of an 11-month-old patient with a right ASH and undescended testis are reported.