Pediatric emergency medicine trisk 1185 1185

An accumulation of fluid within the tunica vaginalis that surrounds the testis—a
hydrocele—is common in newborns; but also occurs with torsion of the testis or
an appendage, epididymitis, trauma, or tumor. Examination of the underlying
testis is required to exclude these conditions. If the testis can be felt to be normal
and there is no abnormality of the overlying scrotal skin, it is a simple hydrocele.
It represents fluid left in place after the processus vaginalis has closed. When the
size of the hydrocele has no history of waxing or waning, it is considered a
simple, noncommunicating hydrocele. Usually, the fluid is reabsorbed in the first
12 to 18 months of life.
If the hydrocele has a clear-cut history of changing in size (often with crying or
exertion), particularly if it is associated with thickening of the cord structures as
they are felt against the pubic tubercle (the silk-glove sign), then the processus
vaginalis is patent and the diagnosis is a communicating hydrocele ( Fig. 61.8 ).
The processus vaginalis did not close spontaneously and may enlarge to permit
the development of hernia. Surgical exploration and high ligation of the processus
vaginalis with decompression of the hydrocele is appropriate treatment. Since a
scrotal hernia may be confused with a hydrocele, aspiration should never be
carried out in children, except by an experienced urologist.