Torsion of tunica vaginalis cyst within hydrocele: case report and review of the literature

Torsion of an intrascrotal mesothelium-lined cyst within a hydrocele, such as a tunica vaginalis cyst, is an extremely rare clinical entity. Its presentation often mimics other pediatric disorders that cause acute scrotal swelling and pain. Here, we describe the case of a 6-year-old boy with a known history of a right spermatic cord hydrocele who presented with acute scrotal symptoms lasting 36 h. Emergency surgery was performed for suspected torsion of an intrascrotal lesion. Intraoperatively, a combined laparoscopic and open right scrotal exploration was performed, revealing bilateral patent processus vaginalis (PPV). After incising the tunica vaginalis, torsion of a cyst within the right hydrocele was confirmed. Laparoscopic high ligation of the bilateral processus vaginalis was completed using the hernia needle technique, followed by cyst resection. Pathological examination subsequently confirmed a mesothelium-lined necrotic tunica vaginalis cyst. To our knowledge, this report describes a combined laparoscopic and open scrotal exploration approach for a torsioned tunica vaginalis cyst. This strategy may represent a viable management option for this uncommon scrotal lesion. However, as a single-center case report, larger series of comparable cases are needed to confirm our clinical observations.