Inguinal hernia is usually a reducible swelling which comes with cry or cough impulse. Whereas a hydrocele is a tense, cystic, clinically irreducible swelling without any impulse.In Hydrocele, the parents will give a characteristic history of swelling of hydrocele being less during morning and then it gradually increases in size during the day. Transillumination test is not reliable as it can be present in both the cases.
The pathogenesis of both hernia and hydrocele is same, that is persistence of processus vaginalis. In majority of the hydrocele cases, the neck of hydrocele is very narrow and so even if you try to compress the swelling, the fluid from processus vaginalis will not go into the abdominal cavity.
The confusion between hydrocele and hernia is common at any age. Once the decision to operate is conveyed to the parents it does not matter since the surgery in both the conditions is same which is the ligation of patent processus vaginalis.
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