Hydrocele after peritoneal dialysis: persistence of the peritoneal-vaginal duct.

Persistent peritoneal-vaginal duct can lead to the appearance of four pathologies, depending on the degree of its obliteration: inguinoscrotal hernia, communicating hydrocele, simple hydrocele or spermatic cord cyst. Likewise, it is associated with cryptorchidism and anomalies in the development of the epididymis. We present the case of a 40-year-old male patient with a history of renal failure secondary to renal polycystosis. He initiated a program of peritoneal dialysis, and we immediately observed passage of liquid to the right scrotal region. Physical examination ruled out the existence of an inguinal hernia. A scrotal/abdominal ultrasound showed evidence of a right communicating hydrocele. With the initial diagnosis of permeable embryonic vaginal process, we decided on surgery to perform its resection. The procedure was begun with a right inguinal incision. We proceeded with the dissection of the spermatic cord with individualization of its elements and the observed existence of the permeable peritoneal-vaginal duct that measured 0.5 cm in diameter (Fig. 1). The duct was resected with ligation and proximal dissection at the internal inguinal orifice and distal ligation and dissection at its scrotal end. Hernioplasty was carried out with a mesh plug in the internal inguinal ring. The patient was discharged and followed-up in the outpatient clinic without incident; peritoneal dialysis was re-initiated after one month, with no complications. The formation of the peritoneal-vaginal duct is completed in the third month of gestation with evagination of the coelom on each side of the midline toward the scrotal fold. Between the third month and the end of gestation and directed by the fibers of the gubernaculum testis, the testicle descends from its primitive retroperitoneal location to the scrotal region. Afterwards, the vaginal process of the peritoneum is obliterated, forming a fibrous cord called the Cloquet ligament. The distal part of the duct becomes the tunica vaginalis of the testicle. In 40% of cases, this obliteration is completed in the last weeks of gestation. In the remaining 60%, it closes before the end of the first year of life.