Advances in the diagnosis and management of abdominoscrotal hydrocele: a narrative review.

Abdominoscrotal hydrocele (ASH) is a rare variant of hydrocele characterized by contiguous scrotal and abdominal fluid collections communicating through the inguinal canal. Its pathogenesis remains poorly understood, and the available evidence is derived primarily from case reports and small retrospective case series, leaving continued uncertainty over its diagnosis, timing of intervention, and operative strategy. This narrative review summarizes and critically discusses the current literature on the pathogenesis, clinical presentation, imaging evaluation, differential diagnosis, and management of pediatric ASH. In children presenting with an apparently simple hydrocele, an unusually large, tense, or progressively enlarging inguinoscrotal swelling, ipsilateral lower abdominal fullness, or cross-fluctuation should prompt ultrasonographic assessment extending from the scrotum through the inguinal canal. Direct demonstration of continuity between the scrotal hydrocele and an abdominal fluid collection supports the diagnosis of ASH. Magnetic resonance imaging may be useful when the proximal extent or anatomical origin of the lesion remains unclear. Proposed mechanisms include pressure-driven cephalad extension of a scrotal hydrocele and persistent patency of the processus vaginalis, although neither mechanism fully accounts for all reported cases. Observation may be appropriate in carefully selected asymptomatic infants with close follow-up, whereas progressive, symptomatic, compressive, or diagnostically uncertain lesions generally warrant surgical intervention. Inguinal, scrotal, and laparoscopic approaches are all feasible, but the available evidence does not demonstrate the superiority of any single technique. Multicenter studies with standardized diagnostic criteria and long-term outcome reporting are needed to inform risk-stratified management.