Cause of primary vaginal hydrocele and ascites in advanced liver cirrhosis.

Primary hydrocele occurs due to a great reduction in protein outflow from the tunica vaginalis cavity and is not due to obstruction of fluid outflow because fluid continues to flow at a nearly normal rate. Fluid collects because of the increased osmotic pressure due to retained proteins and cholesterol. In other words, the fluid is captured from within the sac. Increased capillary permeability is secondary to the increased amount of hydrocele fluid. In idiopathic hydrocele, the hinderance of protein is due to the obstruction of the pores in the intercellular cement substance of the seroendothelial membrane. In acquired hydrocele, the hinderance of protein is due to lymphatic obstruction. The same mechanism may be applied to the occurrence of ascites in advanced liver cirrhosis. If we are able to recognize the substance that occludes the intercellular pores and dissolve it so the occluded pores are reopened, thus allowing the passage of hindered proteins, operation can be avoided and the problem of ascites can be solved.