Persistent processus vaginalis presenting as hydrocele and hernia


  • S. Prabakaran Department of Paediatric Surgery, Government Mohan Kumara Mangalam Medical College and Hospital, Salem, Tamil Nadu, India
  • K. Kasthuri Thilagam Department of Pathology, Government Mohan Kumara Mangalam Medical College and Hospital, Salem, Tamil Nadu, India



Children, Hydrocele, Histological findings, Inguinal Hernia, Mesothelium, Processus vaginalis, Smooth muscle


Background: Inguino-scrotal swelling is a common finding in the paediatric population, attributed to the persistent processus vaginalis. But the reason why some children present with hernia and some with hydrocele is not yet clear. Histological examination of the sac may be useful in understanding the reason for this differential presentation. Hence the current study was undertaken to assess the association between type of clinical presentation and histological findings in pediatric population.

Methods: A prospective observational study was done on 51 children aged below 12 years presenting with inguinoscrotal swelling and subsequently diagnosed with either hernia or hydrocele and treated with surgical intervention. The samples were sent for histological examination and analysed for association with diagnosis.

Results: There were 31 Inguinal hernia and 20 Hydrocele subjects. The predominant age group was 6 to 10 years. The number of children with hydrocele right and left, inguinal hernia right and left was 21 (41.2%), 10 (19.6%), 17 (33.3%) and 3(5.9%) respectively. All hydrocele subjects had mesothelial lining, smooth muscle but scanty lymph vessels and absent inflammatory cells. 95% of the Inguinal hernia subjects had low cuboidal lining, inflammatory cells, and lymph vessels.

Conclusions: Paediatric inguinal hernias and hydroceles are due to incomplete or abnormal obliteration of the processus vaginalis. Mesothelial lining, Presence of smooth muscle, Scanty lymph vessels, absence of inflammatory cells are characteristic of Hydrocele Inguinal hernia is characterized by low cuboidal lining, absence of smooth muscles, presence of lymph vessels and inflammatory cells.


Kaplan GW. Scrotal swelling in children. Pediatr Rev. 2000;21(9):311-4.

Palmer LS. Hernias and hydroceles. Pediatr Rev. 2013;34(10):457-64.

Notes PS. Inguinal hernias and hydroceles in infancy and childhood: A consensus statement of the Canadian Association of Paediatric Surgeons. Paediatrics Child Health. 2000;5(8):461-2.

Clarnette TD, Rowe D, Hasthorpe S, Hutson JM. Incomplete disappearance of the processus vaginalis as a cause of ascending testis. J Urol. 1997;157(5):1889-91.

Favorito LA, Costa WS, Sampaio FJ. Relationship between the persistence of the processus vaginalis and age in patients with cryptorchidism. Int Braz J Urol. 2005;31(1):57-61.

Rafailidis V, Varelas S, Apostolopoulou F, Rafailidis D. Nonobliteration of the processus vaginalis. Sonography of related abnormalities in children. J Ultrasound Med. 2016;35(4):805-18.

Patil V, Shetty SMC, Das S. Common and uncommon presentation of fluid within the scrotal spaces. Ultrasound Int Open. 2015;1(2):E34-40.

Skoog SJ, Conlin MJ. Pediatric hernias and hydroceles. The urologist's perspective. Urol Clin North Am. 1995;22(1):119-30.

Lau ST, Lee YH, Caty MG. Current management of hernias and hydroceles. Semin Pediatr Surg. 2007;16(1):50-7.

Rahman N, Lakhoo K. Patent processus vaginalis: a window to the abdomen. Af J Paediatr Surg. 2009;6(2):116-7.

Tanyel FC, Dagdeviren A, Muftuoglu S, Gursoy MH, Yuruker S, Buyukpamukcu N. Inguinal hernia revisited through comparative evaluation of peritoneum, processus vaginalis, and sacs obtained from children with hernia, hydrocele, and undescended testis. J Pediatr Surg. 1999;34(4):552-5.

Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiograph. 2003;23(1):215-40.

Renzulli JF, Shetty R, Mangray S, Anderson KR, Weiss RM, Caldamone AA. Clinical and histological significance of the testicular remnant found on inguinal exploration after diagnostic laparoscopy in the absence of a patent processus vaginalis. J Urol. 2005;174(4)(2):1584-6.

IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Available at:

Steward DJ. Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiol. 1982;56(4):304-6.

Gobel P, Stuhldreier G. Inguinal hernia, and hydrocele-special features in infants and children. Zentralbl Chir. 2008;133(6):531-4.

Lao OB, Fitzgibbons RJ, Cusick RA. Pediatric inguinal hernias, hydroceles, and undescended testicles. Surg Clin North Am. 2012;92(3):487-504.

Erdogan D, Karaman I, Aslan MK, Karaman A, Cavusoglu YH. Analysis of 3,776 pediatric inguinal hernia and hydrocele cases in a tertiary center. J Pediatr Surg. 2013;48(8):1767-72.

Garriga V, Serrano A, Marin A, Medrano S, Roson N, Pruna X. US of the tunica vaginalis testis: anatomic relationships and pathologic conditions. Radiograph. 2009;29(7):2017-32.






Original Research Articles