Cholesterol calculi in hydrocele: a rare and unusual finding: a case report

Abstract

Cholesterol lithiasis of hydrocele is a very rare urological disorder where cholesterol stones are produced within the sac of hydrocele, frequently due to chronic inflammation, protracted stasis of fluid, and degeneration of adjacent paratesticular tissues. These intrahydrocele stones or scrotal pearls are usually asymptomatic and are found incidentally on imaging or during operation. With fewer documented cases worldwide, the disorder represents an opportunity for diagnostic and therapeutic dilemma. The case is presented here of a 35-year-old man with a 10-year history of painless slowly progressive swelling of the left scrotum. High-resolution ultrasonography was characterized by an anechoic collection and two hyperechoic mobile masses with posterior acoustic shadowing, indicative of cholesterol calculi. A Jaboulay's procedure for surgical exploration was done. Intraoperatively, about 300 mL of serosanguinous fluid and three cholesterol stones were evacuated from a thickened hydrocele sac. The left testis and opposite scrotum were normal. Histopathology was proven to be cholesterol crystal deposition with chronic inflammatory changes. This case highlights the importance of keeping cholesterol lithiasis in the differential diagnosis of chronic hydroceles, particularly when unusual sonographic imaging is encountered. It also supports the preoperative diagnosis with ultrasonography and reiterates the effectiveness of Jaboulay's procedure as a safe, effective, and simpler surgery to be considered. Increased awareness of this uncommon condition could lead to earlier diagnosis, proper surgical planning, and improved patient outcomes.