Abdominoscrotal hydrocele (ASH) is the rarest type of hydrocele. This condition is characterised by a large abdominal and scrotal component connected by an isthmus within the inguinal canal. The incidence among the paediatric population is reported to be less than 3%, although it might be underdiagnosed. Several theories have been proposed in the literature but the aetiology of ASH remains unknown. Diagnosis can be made clinically and confirmed by ultrasound. Spontaneous resolution is rare and long-standing ASH may lead to complications, thus early surgical intervention is recommended. Different techniques have been described, but dissection remains challenging due to the tunica vaginalis adherence to the testis and the distal cord. We present a male infant with ASH who underwent inguinal repair. The procedure was facilitated by needle decompression of the mass. Identification and preservation of the vessels and vas deferens was done successfully without compromising the testis.
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