Hernia/Hydrocele

Description: 

What is a Hydrocele?
The newborn scrotum can be filled with clear fluid. The fluid is squeezed into the scrotum during the birth process. This painless collection of fluid surrounding the testicle is called a hydrocele. It is common in newborn males. A hydrocele may take 6-12 months to clear completely. It is harmless but can be re-checked during regular visits.

Why does it occur?
The causes of hydroceles that develop in children are different from those that result in hydroceles in adults. The testicles initially develop in the abdomen. In most boys, they move down into the scrotum before birth. As they do this, some of the lining of the abdomen (called the peritoneum) comes down as a tube with the testicle. In most boys, the tube that forms the connection between the peritoneum and scrotum is closed at birth, but in some boys it remains open. Fluid produced in the abdomen can then freely move into the scrotum and back (which accounts for the changes in size often observed).

What is a hernia?
An inguinal hernia occurs when a loop of bowel slips into the scrotum through the inguinal ring. There are usually no symptoms (unless the intestines get stuck), but the mass feels soft and separate from the testicle. The mass can usually be pushed up into the peritoneal cavity.

Is it serious?
Not usually. However, it is something that if ignored can become a problem. Sometimes, the intestine gets trapped in the connection and the intestine can kink. When this occurs, the child will be extremely fussy or uncomfortable (severe, persistent crying), may vomit, and have diarrhea or constipation. If these symptoms are due to a hernia, there may be a larger bulge than before and it may be firmer, redder, or tender to touch. This is a situation that deserves immediate attention by your pediatrician or pediatric urologist. Fortunately, this situation seldom occurs.

How is this problem repaired?
This problem can be corrected with a small operation that is done as a day surgical procedure. A small incision is made in the groin so that the intact connection can be found and opened, the fluid drained, and then tied off to close the connection between the abdomen and scrotum. The intact connection may be present on the opposite side in up to 10% of children without showing any signs of being there. We will often test to see if it is present at the time we repair the obvious side and if a problem is found on the opposite side, it can be repaired at the same time.

Should a Hydocele be fixed as soon as possible?
No, not necessarily. Most hydroceles are discovered in newborn babies. In fact, about 1 in 3 newborn boys has a small hydrocele. Fortunately, in the majority, the connection will close by age 1 year. In premature boys, the number of hydroceles is higher. If, however, the hydrocele is still present at age 12 months, it is not likely to go away by itself and should be corrected surgically. If there is a definitive hernia with bowel in it, repair during infancy should be performed.