Jitendra T Sankpal, MBBS, MS, FMAS, FIAGS1, Pradip S Kasabe, MBBS, MS, FMAS, FIAGS2, Priyadarshini M Deodurg, MBBS, MS3, Mukund B Tayade, MBBS, MS1, Khushboo N Kadakia, MBBS1, Sweety S Agarwal, MBBS, DNBE1, Sushrut Sankpal, MBBS4, Priyanka Saha, MBBS1, Atish K Parikh, MBBS1, Rukmini Waghmare, MBBS1. 1Grant Government Medical College And Sir JJ Group Of Hospitals, 2Dr Vaishampayan Memorial Government Medical College Solapur Maharashtra India, 3Gulbarga Institute Of Medical College Kalaburagi, 4Rajiv Gandhi Medical College Thane Maharashtra India
INTRODUCTION: Hydrocele-en-bissac, also called abdomino-scrotal hydrocele, is an extremely rare clinical entity. Until now only 94 cases in adults and fewer than 20 cases in children have been reported in world literature, with surgical management being the only option. An innovative, minimally invasive laparoscopic excision of the abdominal sac was performed and the scrotal component was managed by Jaboulay's Procedure. This is probably the first case report in world literature describing laparoscopic management of hydrocele-en-bissac.
CASE REPORT: A 50 year old male presented with complaints of bilateral hydrocele and swelling in right lower abdomen since one year. Computed tomography of the abdomen revealed an encysted hypodense lesion with enhancing walls along the right side of pelvis, anterior to the psoas muscle and extending through the internal ring into the right inguinal region upto the scrotal sac; measuring 14.1cm x 3.6cm suggestive of an encysted hydrocele of cord associated with hydrocele of both scrotal sacs.
On diagnostic laparoscopy, an intra-abdominal cystic swelling separate from the bowel was found in relation to the cord extending into the right inguinal canal suggestive of hydrocele-en-bissac. Peritoneal sac was dissected and distal end of the abdominal sac was ligated with polyglactin suture. The sac was then excised and delivered out through one of the ports. Jaboulay's procedure of eversion of sac was done for the scrotal component of the hydrocele-en-bissac on the right and hydrocele on the left side. Histopathology report was consistent with encysted hydrocele of cord.
DISCUSSION: Hydrocele-en-bissac was first described by Dupuytren in 1834. Jacobson classified it as an infantile hydrocele with intra-abdominal extension. Some theories postulate that hydrocele-en-bissac occurs as a result of increased intaluminal pressure confined to a proximally closed processus vaginalis; this increased pressure allows extension into the retroperitoneal space through the internal ring causing both abdominal and scrotal swellings.
CONCLUSION: In the era of minimally invasive surgery, the benefit of laparoscopy was offered to the patient for excision of the abdominal component of hydrocele-en-bissac with better cosmetic outcome. Laparoscopic approach offers a safe and effective treatment modality with early recovery to this rare clinical entity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86962
Program Number: P726
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster