Isolated funicular hydrocele in an infant mimicking inguinoscrotal hernia: diagnostic challenges and surgical lessons in a low-resource setting: a case report

Abstract

Background: Funicular hydrocele is a congenital spermatic cord hydrocele caused by the partial persistence of the processus vaginalis. In infants, it may mimic an inguinal hernia clinically and radiologically, creating diagnostic uncertainty. Differentiating these conditions is important because the anatomical subtype determines surgical management. Case presentation: A 6-month-old male infant presented with a painless left inguinoscrotal swelling of 3 months’ duration. Examination revealed a non-tender, non-reducible cystic swelling extending from the inguinal canal into the upper scrotum. The lesion did not enlarge with crying or straining. Faint transillumination was appreciated near the upper scrotal component, maintaining hydrocele within the differential diagnosis. Ultrasound suggested an inguinoscrotal hernia. Because of persistent swelling and the inability to confidently exclude hernia, surgical exploration was performed. Intraoperatively, a cystic fluid-filled sac was identified along the spermatic cord, extending from the internal ring to the upper testis without communication with the tunica vaginalis, confirming a true funicular hydrocele. Hydrocelectomy with high ligation of the patent processus vaginalis was performed successfully. Recovery was uneventful, and no recurrence was observed during follow-up. Discussion: Funicular hydrocele may closely resemble an inguinal hernia and remains difficult to distinguish clinically in some infants. Although ultrasound improves diagnostic accuracy, interpretation remains operator dependent. Accurate intraoperative identification is important because management differs from encysted hydrocele, and incomplete repair may predispose to recurrence. Conclusion: This case highlights the diagnostic overlap between funicular hydrocele and inguinal hernia, and it reinforces the importance of careful clinical assessment and intraoperative anatomical recognition for appropriate management.