Hydrocele in children
What is it?
Literally, hydrocele means “fluid accumulation”.
The testicle arises under the kidney and descends along the abdomen to the inguinal area. It then passes through the inguinal canal and reaches the scrotum in the seventh month of pregnancy. On its way, the testicle carries a tissue sheath (peritoneo-vaginal duct), which forms a communication channel between the abdominal cavity and the scrotum.
This canal is designed to close spontaneously at birth or during the first year of life.
This is the presence of a scrotal sac, which is swollen, sometimes distended, usually causes no pain and is filled with fluid.
There are two forms: congenital hydrocele and reactive hydrocele.
Causes and risk factors
Two main causes can be distinguished:
- congenital hydrocele: due to the absence of closure of the peritoneo-vaginal duct with the consequent passage of the fluid, usually in the abdominal cavity, into the scrotum;
- reactive hydrocele: due to irritating or traumatic processes affecting the testicle, an inflammatory reaction occurs, resulting in reactive fluid formation around the testicle.
Congenital hydrocele can occur:
- at birth, when 5 out of 100 babies born at the end of pregnancy are affected, and 16-25 out of 100 among premature babies. It may resolve spontaneously during the first year of life. At one year of age, the disease occurs in only 1 in 100 children;
- in the first years of life, infectious or febrile episodes can increase the amount of fluid in the abdomen. This causes increased pressure in the abdomen, which can cause the vaginal-peritoneal canal, which is not securely closed, to stretch and open, causing fluid to enter the scrotum.
Reactive dropsy (hydrocele) affects adolescent boys.
Which are the symptoms?
In most cases, hydrocele is painless, the child does not complain, and the disease is detected by the parents or doctor.
The tumor may be present from birth or appear suddenly, sometimes as a result of infectious diseases or fever. One or both scrotal sacs may appear enlarged in volume, soft to the touch, or very dense and hard.
The size of the hydrocele may vary during the day: it is smaller in the morning because lying down while sleeping allows fluid to drain back into the abdomen, and larger in the evening because of gravity.
Hydrocele can cause the following problems:
- compression of the testicle by fluid contained in the scrotal sac, with subsequent disruption of normal testicular development;
- possible development to the formation of an inguinal hernia: an intestinal loop in the peritoneo-vaginal duct, which can get stuck inside the duct and become choked. This causes severe pain, inconsolable crying, swelling and redness of the inguinal area.
How is it diagnosed?
How is it treated?
Spontaneous resolution of the disease is possible as early as the first year of life. Therefore, in most cases, a person waits until the age of one year before deciding on a possible corrective surgery.
In other cases, the hydrocele may become very voluminous or may be associated with an inguinal hernia, putting the patient at risk for complications. Therefore, corrective surgery is also indicated before the age of one year.
In congenital hydrocele, surgery is aimed at closing the open peritoneo-vaginal duct followed by removal of the fluid around the testicle. The surgery requires an overnight stay or is performed in an outpatient clinic and lasts about 20 minutes. The surgery is final and solves the problem.
In the case of reactive hydrocele, only the fluid and the tissues containing it are removed.
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