Hydrocele in a Sterilized Man

Scrotal enlargement and pain of rapid onset prompted a 28-year-old man to seek medical attention.The testicle was displaced posterior and inferior in the engorged scrotum and wasdifficult to palpate.A hydrocele may develop from trauma or inflammation of the tunica vaginalis testis,which can impede its ability to absorb secreted fluids. These fluids accumulate in the potentialspace between the anterior and posterior tunica, creating the hydrocele.This patient's hydrocele had been present 1 year earlier when he underwent a vasectomy. Thepractitioner who performed the vasectomy drained the hydrocele by needle aspiration in order tofacilitate the elective sterilization. At that time, 7 oz (more than 100 mL) of fluid was drained. Theonset of the first occurrence was verygradual and painless.CPT Kenneth S. Brooks, PA-C,of Camp As Sayliyah, Doha, Qatar,writes that needle aspiration anddrainage is not curative. Virtuallyevery hydrocele managed this wayrecurs.Transillumination is not diagnostic.A loop of small bowel in thescrotum would also transilluminate.In this case, however, the historyof previous hydrocele made the differentialdiagnosis of hernia unlikely,and indeed no inguinal ring defectwas palpated. Because of the rapidonset of swelling and the patient'sdiscomfort, the risk of testicularischemia warranted an immediatesurgical referral. The hydrocele wasrepaired, and the patient's recoverywas uneventful.