What's the deal with the abdoimno-scrotal hydrocele?

As it's name implies, an abdomino-scrotal hydrocele is a hydrocele that extends into the peritoneal cavity. It is a rare variant that makes up 3% of pediatric hydroceles. A recent meta-analysis by Dout et al published in the Journal of Pediatric Surgery looked at a total of 116 cases of abdomino-scrotal hydroceles in an attempt to better define this entity in terms of natural history, management, and clinical implications.

The authors describe a wide variability in natural history reported; ranging form hydroceles that spontaneously resolved to ones that continued to grow. The management strategies were equally varied; ranging from a combined inguinal/laparoscopic approaches to a more simple scrotal approach.

What I found most useful in this study was the association between these hydroceles and testicular dysmorphism.  Based on this report, the incidence of dysmorphism was around 28%. This was felt to be related to the amount of pressure exerted by these hydroceles on the surrounding tissue, including the testicular vessels.

This is relevant because it suggests that there may be benefit to more urgent intervention for an abdomino-scrotal hydrocele compared to the garden-variety non-communicating hydrocele, which one may opt to observe for a period of time.