Morgan Sly*, Kiley Clark*, Emily Downing*, Amr Abdou*, Clay Martin MD*

* American University of the Caribbean School of Medicine

Abdominoscrotal hydrocele (ASH) is an uncommon and benign clinical finding in both the pediatric and adult populations. It is characterized by bilocular or multilocular sacs that extend from the scrotum, through the inguinal canal, and into the abdominal cavity. Approximately 0.17% of adult hydroceles are classified as abdominoscrotal hydroceles. Typically, surgical intervention is warranted for treatment. We are presenting the case of a 57-year-old male with a massive right sided abdominoscrotal hydrocele that underwent hydrocele sac drainage, rather than the standardized treatment of sac excision, due to close proximity of the sac to major vessels and subsequently developed a rare complication of pyocele. This case report presents a rare case of massive abdominoscrotal hydrocele with close proximity of the hydrocele sac to the aorta and IVC complicating surgical intervention. Its addition to the literature may improve the overall optimization of surgical interventions and management of massive ASH, particularly those of which are high risk in terms of damaging major vascular structures. Additionally, we document in the literature that if ASH recurs after undergoing solely drainage as treatment, the development of a seemingly rare entity, a pyocele, is a potential complication.