Elongated and Oval Groin Swelling (Differential Diagnosis Inguinal Hernia)

swel_18a_n.jpg: 7-month-old boy with a large longitudinal and oval swelling of the right groin. The swelling is tight and has a distinct cranial end on palpation. swel_18b_n.jpg: Operative findings: Above the two fingers of the surgeon a cystic and tight structure of grey reddish color becomes visible; at the upper border the two main structures of the spermatic cord are recognizable. swel_18c_n.jpg: Preparation of the described structure containing a yellow fluid shining through and continues in a small tract and in a peritoneal tip. swel_18a_n.jpg, swel_18b_n.jpg and swel_18c_n.jpg: The diagnosis is a hydrocele of the cord (funicular hydrocele) of the right side which consists of cystic dilatation of the otherwise closed processus vaginalis. The very thin persistent connective tract to the peritoneal cavity (siehe swel_18c_n.jpg) allows the filling of the hydrocele with peritoneal fluid. The hydrocele of the cord is an important differential diagnosis of the inguinal hernia and occurs in girls as well (Nuck's cyst). In contrast to the smooth, conically and continuously proceeding inguinal hernia in direction of the internal ring, the hydrocele of the cord is tight, cystic and dinstinctly ending at the external ring of the inguinal channel, and is not reducible. Because there is no spontaneous healing in the cyst of the cord, elective surgery is indicated. In case of suspicion of a combination with an irreponible or incarcerated proximally situated inguinal hernia or of impossibility to differentiate between the two pathologies, urgent surgery is needed.