The treatment of abdominoscrotal hydrocele: Is there a role for nonoperative management?

Background/PurposeAbdominoscrotal hydrocele (ASH) is an uncommon entity. Until now, the recommended treatment has been surgical. There is only one successful case of nonoperative management reported in literature. We report the largest series of children with ASH, and provide evidence in support of an initial nonoperative approach.MethodsThis study is a retrospective chart review of patients treated from 1994 to 2015 with ASH at a single institution.ResultsThirty patients were identified with ASH, with 29 included in the analysis. Nine patients (30%) had operative management with an 80% complication rate.Twenty out of 29 patients (70%) were initially managed expectantly. Sixteen (80%) had resolution of their abdominal component, twelve (60%) of which went on to have full resolution of ASH. Four patients (20%) in this group required operative management of ASH.ConclusionsASH should be included in the differential diagnosis of pediatric scrotal swelling. The “Springing Back Ball Sign” should be used as a screening tool. If it is positive, a dynamic ultrasound should be performed to confirm the diagnosis. We recommend observation as the first step in the management of uncomplicated ASH. It can result in avoidance of operation or at least lower the complication risk significantly if operation is required.Level of Evidence: 4.