Giant Hydrocele in a Decompansated Cirrhotic Patient: Not Always Up Sometimes Down

Letter to the Editor

Austin J Nucl Med Radiother. 2016; 3(1): 1018.

Giant Hydrocele in a Decompansated Cirrhotic Patient: Not Always Up Sometimes Down

Ergenc H, Eminler AT*, Ilce HT, Koksal AS and Parlak E

Faculty of Medicine, Department of Internal Medicine, Gastroenterology and Nuclear Medicine, Sakarya University, Turkey

*Corresponding author: Ahmet Tarik Eminler, Faculty of Medicine, Department of Gastroenterology, Sakarya University, Korucuk, Sakarya, Turkey

Received: June 21, 2016; Accepted: June 22, 2016; Published: June 24, 2016

Abstract

Hydrocele denotes a pathological accumulation of serous fluid in a body cavity. Ascites is the most common complication of cirrhosis and it causes an increase in the intra abdominal pressure. Here in we report an alcoholic cirrhotic patient with giant hydrocele that is communicating with ascites. We showed the peritoneo-scrotal communication by intraperitoneal injection of Tc-99m macro aggregated albumin. Communicating shunt between peritoneal cavity and scrotum should be considered in the decompensated cirrhotic patient with resistant scrotal enlargement.

Keywords: Hydrocele, Ascites, Cirrhosis

Letter to the Editor

Hydrocele denotes a pathological accumulation of serous fluid in a body cavity. Also the term is used usually to describe “hydrocele testis” which is the accumulation of fluids around a testicle. It is often caused by fluid secreted from a remnant piece of peritoneum wrapped around the testicle, called the tunica vaginalis [1]. Most pediatric hydroceles are congenital and adult hydroceles are usually secondary. The latter can present acutely from local injury, infection, radiotherapy, or increased intra abdominal pressure [2]. Ascites is the most common complication of cirrhosis and it causes an increase in the intra abdominal pressure. Here in we report an alcoholic cirrhotic patient with giant hydrocele that is communicating with ascites.

60 years old male patient with a history of decompensate alcoholic cirrhosis was admitted to the hospital with the complaints of progressive symptomatic scrotal enlargement over the last few months (Figure 1). Abdominal ascites was not clinically evident, but ultrasound examination showed minimally ascites between the intestinal loops. The scrotal Doppler ultrasonography performed for existing scrotal swelling and detected an advanced increase in the amount of bilateral scrotal fluid and has been interpreted as hydrocele. The swollen hemiscrotum was painless and transilluminated, providing evidence of a hydrocele. To detect the presence of a communicating hydrocele, peritoneal Scintigraphy was performed by intraperitoneal injection of 1 mCi Tc-99m macro aggregated albumin was injected with in the minimal ascites detected by ultrasonography. The images showed radio tracer accumulation within the peritoneal cavity and bilateral scrotum that more prominent on the right side (Figure 2). A hydrocele resulting from a communicating shunt between the peritoneal cavity and scrotum was confirmed.

Citation: Ergenc H, Eminler AT, Ilce HT, Koksal AS and Parlak E. Giant Hydrocele in a Decompansated Cirrhotic Patient: Not Always Up Sometimes Down. Austin J Nucl Med Radiother. 2016; 3(1): 1018.