Recurrent Hydrocoele
GP is a 72-year old man with massive recurrent hydrocoele of his right scrotum. The first episode occurred 4 years ago which he did not notice until the scrotal swelling made walking difficult. He presented to his family doctor who aspirated 480 cc of straw-color fluid. However the problem recurred 5 more times over the next 48 months despite needle aspiration. Repeated ultrasound and magnetic resonance imaging of his pelvis and abdomen had not revealed any specific pathology or obstructive mass that could explain this recurrent lesion. Moreover, bacterial culture, malignant cytology and acid fast bacilli staining had been performed on three of the six previous aspirates, which were all negative. The smallest amount of fluid drained was 400 cc and the largest amount was from the most recent visit (640 cc) []. Patient suffered from multiple comorbidities including hypertension, dyslipidemia, atrial fibrillation, congestive heart failure, generalized epilepsy, and benign prostatic hypertrophy. Past medical history included repaired aortic artery dissection, pneumothorax, transient ischemic attacks, thromboembolism and subarachnoid hemorrhage. Patient is a 60 pack-year smoker with problem of alcohol abuse. He is on disability and lives alone with poor social and family support. He takes a diuretic for his hypertension but there was no previous history of proteinuria. Surgical consult pointed to a patent hernia sac as the contributing cause of the recurrent hydrocoele. Mesh repair of right inguinal hernia was performed six months ago but the hydrocoele recurred shortly afterwards. Further surgical options including resection, eversion orhydrocoelectomy had been considered but were considered as less favorable in view of the co-existing comorbidities of the patient. A primary or metastatic source of malignancy remained on the list of differentials but could not be excluded. The recurrent hydrocoele would never bothered the patient except when it reached a size that he could not walk smoothly.