Massive drainage from incision after tunica vaginalis eversion: A case of patent processus vaginalis

A 68-year-old male on hemodialysis developed torrential incisional leakage (2000-3000 mL/day) 5 days after left testicular tunica vaginalis eversion. Fluid analysis confirmed ascites. Imaging revealed a patent processus vaginalis communicating with the incision. Conservative management with inguinal compression dressing and dialysis optimization achieved complete resolution within 72 hours. Follow-up at 2 months showed no recurrence. This represents the first documented hemodialysis-associated communicating hydrocele leakage. Successful closure resulted from: 1) pressure gradient reversal collapsing the processus vaginalis, and 2) restored lymphatic equilibrium (drainage > ascites production) without surgical intervention.