An accumulation of fluid within the tunica vaginalis that surrounds the testis—a hydrocele—is common in newborns; but also occurs with torsion of the testis or an appendage, epididymitis, trauma, or tumor Examination of the underlying testis is required to exclude these conditions If the testis can be felt to be normal and there is no abnormality of the overlying scrotal skin, it is a simple hydrocele It represents fluid left in place after the processus vaginalis has closed When the size of the hydrocele has no history of waxing or waning, it is considered a simple, noncommunicating hydrocele Usually, the fluid is reabsorbed in the first 12 to 18 months of life If the hydrocele has a clear-cut history of changing in size (often with crying or exertion), particularly if it is associated with thickening of the cord structures as they are felt against the pubic tubercle (the silk-glove sign), then the processus vaginalis is patent and the diagnosis is a communicating hydrocele ( Fig 61.8 ) The processus vaginalis did not close spontaneously and may enlarge to permit the development of hernia Surgical exploration and high ligation of the processus vaginalis with decompression of the hydrocele is appropriate treatment Since a scrotal hernia may be confused with a hydrocele, aspiration should never be carried out in children, except by an experienced urologist