Giant Abdominoscrotal Spermatic Cord Hydrocele Mimicking Inguinal Hernia and Urinary Retention: A Case Report

Abdominoscrotal hydrocele (hydrocele en bissac) is characterized by a dumbbell-shaped fluid collection with scrotal and abdominal components connected through the inguinal canal and deep inguinal ring.An encysted spermatic cord hydrocele with this configuration is rare in adults.We report the case of a 69-yearold man with a solitary right testis following a previous left orchidectomy, who presented with a one-month history of an enlarging right groin swelling.Initial general surgical assessment favored an inguinoscrotal hernia, as the examiner could not get above the swelling, which appeared to demonstrate a cough impulse.Transillumination was not assessed.Contrast-enhanced computed tomography (CT) subsequently demonstrated a 25 cm encysted spermatic cord hydrocele extending into the pelvis, without bowel involvement.At a later outpatient appointment for uroflowmetry, an automated bladder scanner recorded a volume exceeding 1,000 mL, prompting urgent referral for presumed urinary retention.Urethral catheterization yielded less than 15 mL of urine.Review of the CT images established that the scanner had measured the pelvic component of the hydrocele.The patient underwent elective hydrocele surgery through a scrotal approach, with drainage of approximately 2 L of clear fluid and eversion of the sac.No recurrence was identified at 12-week follow-up.This case highlights two important diagnostic pitfalls: an inability to get above an inguinoscrotal swelling does not distinguish a hernia from a hydrocele with abdominal extension, and automated bladder scanner readings may be falsely elevated by adjacent pelvic fluid collections.Clinical findings and existing imaging should be reconciled with unexpected bladder scan measurements before invasive intervention.