Bilateral abdominoscrotal hydroceles causing vascular compression in an infant: a case report

Introduction

An abdominoscrotal hydrocele is a rare condition characterized by a large fluid-filled mass that spans scrotal, inguinal and intrabdominal components. Early surgical management is recommended in order to prevent complications from compression or torsion.

Case presentation

A previously healthy two-month-old male initially presented to a surgery clinic with asymptomatic congenital bilateral scrotal hydroceles; this was managed conservatively. He presented again at five months of age to the emergency department with acute right lower extremity swelling and mild discoloration. Testicular ultrasound showed large bilateral abdominoscrotal hydroceles. Magnetic resonance imaging angiogram additionally showed right external iliac vein opacification adjacent to the ipsilateral abdominoscrotal hydrocele, suggestive of compression or thrombosis. Duplex ultrasound of the iliac vessels showed significant narrowing of the right external iliac vein with associated turbulent, high-velocity flow. The patient underwent bilateral hydrocelectomy via open inguinal incisions and recovered well. Follow-up Doppler ultrasound was performed two weeks postoperatively and showed resolution of the prior right external iliac vein compression.

Conclusion

Bilateral abdominoscrotal hydroceles are rare and can present with vascular complications. Surgical management is recommended in symptomatic and complicated cases of abdominoscrotal hydroceles.