There is a passage between the abdomen and the groin through which the testicle passes from the abdomen to the scrotum in males around mid-pregnancy. This passage normally closes before the baby is born. When this passage does not close, a hernia or hydrocele can result. A “communicating hydrocele” is when just fluid from the abdomen passes back and forth to the scrotum. This is like an indirect inguinal hernia, which means that intestinal contents are passing through the passage. From an anatomy standpoint, these are essentially the same in children. In adults, a hernia and hydrocele are different.
A simple hydrocele is common at birth and is where fluid is trapped in the scrotum but the passage is closed. These typically resolve on their own in the first year of life.
What are the Symptoms of Hydrocele/Hernia?
When a hydrocele is present, a nontender mass or bulge is seen in the groin or scrotum. A communicating hydrocele or hernia will change in size, becoming larger when a baby is crying, or if older, when the child is walking. The bulge will be smaller in size when the child is sleeping or quiet. A hydrocele or hernia is usually not painful. But, some infants do experience pain. You may notice your infant is more irritable, cries more often and pulls their legs up to their belly. Sometimes parents notice that communicating hydroceles are more swollen at the end of the day in toddlers and young children.
A communicating hydrocele should not cause any harm to the testicle, but it can enlarge over time to develop into a hernia. When there is a bulge in the groin, that can mean stomach contents like the intestines are sliding into the passage. As long as the stomach contents can be pushed back into the abdomen (called a reducible hernia), then the situation is not urgent. If, however, the stomach contents become stuck and cannot be pushed back into the abdomen, it is called an incarcerated hernia. This needs to be treated urgently. If your child begins vomiting, has extreme tenderness of the area, a black-and-blue look to the groin or scrotum, fever or diarrhea, the hernia may have become strangulated. This can result in a blockage of the bowel or damage to its blood supply and is considered an emergency to treat.
Sometimes, there is a double hernia where there is a hernia or communicating hydrocele on both sides. They may show up together or at different times.
