Hybrid Approach to Abdominoscrotal Hydrocoele in Adult: A Rare Case Scenario

Abstract

Background: Abdominoscrotal hydrocele is an uncommon condition characterised by communicating scrotal and abdominal components extending through the inguinal canal. Adult presentation is particularly unusual, and large lesions may produce pressure effects on adjacent abdominal and pelvic structures. Presentation of Case: A 71-year-old man presented with progressive right scrotal swelling for six years and pain involving the right hemiscrotum and abdomen for approximately four months. Clinical examination and imaging demonstrated a very large right-sided abdominoscrotal fluid collection extending through the inguinal region. Ultrasonography showed a large collection with an atrophied right testis, while CT and MRI confirmed marked abdominal extension with displacement and compression of adjacent pelvic structures. Diagnostic laparoscopy demonstrated the abdominal component and adhesions surrounding the sac. After adhesiolysis, approximately 9 L of brownish fluid was drained. Because complete laparoscopic separation of the large sac was not feasible, a right inguinoscrotal incision was made. The sac was excised, and orchidectomy was performed because the right testis was non-viable. The posterior wall of the inguinal canal was repaired. Histopathological examination confirmed a hydrocele sac with right testicular tissue. Conclusion: A combined laparoscopic and open approach was technically feasible for this exceptionally large adult abdominoscrotal hydrocele and allowed assessment of the abdominal extension followed by definitive excision.