A single-stage reconstruction on giant scrotal lymphedema: a case report

David Ralph Lienhardt Ringoringo; Ramlan Nasution; Kharisma Prasetya Adhyatma

doi:10.15562/bmj.v11i1.2907

A single-stage reconstruction on giant scrotal lymphedema: a case report

David Ralph Lienhardt Ringoringo ,

Ramlan Nasution ,

Kharisma Prasetya Adhyatma ,

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DOI: https://doi.org/10.15562/bmj.v11i1.2907 |
Published: 2022-04-30

Abstract

Introduction: Scrotal lymphedema is a rare condition characterized by the swelling of the scrotal skin due to deterioration in lymphatic drainage. Although not life-threatening, chronic lymphedema is disabling with significant physical and psychological morbidity and complications, including impaired hygiene, urinary incontinence and immobility. This report aimed to describe the diagnosis and treatment of giant scrotal lymphedema.

Case Presentation: A 23-year-old man presented with a gradually enlarging scrotum. Physical examination of the genitalia shows that the patient’s penis was difficult to identify, and testes were completely impalpable due to the thickness of the scrotal skin. There were neither inguinal lymph node enlargement nor other skin lesions on the scrotum. The scrotum was homogenous, with a measured dimension of 35 cm x 28 cm x 20 cm anterior to posterior. Laboratory evaluation, including complete blood count, complete metabolic panel, human immunodeficiency virus, sedimentation rate, and antibodies to strongyloides, schistosomes, and filaria, were within normal limits. The penis and testes were normal-sized and clearly demarcated from computed tomography scan, buried within the hardened scrotal soft tissues, with no signs of testicular tumor or any pelvic lymph node enlargement.

Conclusion: Scrotal lymphedema is a rare condition characterized by the swelling of the scrotal skin due to deterioration in lymphatic drainage.

References

Akan S, Urkmez B, Artuk I, Urkmez A. Scrotal Lymphedema and its Conservative Treatment: A Rare Complication of Circumcision. J Coll Physicians Surg Pak. 2020;30(1):94-95. doi:10.29271/jcpsp.2020.01.94.
Wiryadana, K., Putra, I.W., Rahayu, P.D., Pradnyana, M., Adelaida, M. and Sudarmaja, I. 2018. Risk factors of soil-transmitted helminth infection among elementary school students. Paediatrica Indonesiana. 57, 6 (Jan. 2018), 295-302. DOI:https://doi.org/10.14238/pi57.6.2017.295-302.
Taylor MJ, Hoerauf A, Bockarie M. Lymphatic filariasis and onchocerciasis. Lancet. 2010;376(9747):1175-1185. doi:10.1016/S0140-6736(10)60586-7.
Schook CC, Kulungowski AM, Greene AK, Fishman SJ. Male genital lymphedema: clinical features and management in 25 pediatric patients. J Pediatr Surg. 2014;49(11):1647-1651. doi:10.1016/j.jpedsurg.2014.05.031.
Salako AA, Olabanji JK, Oladele AO, Alabi GH, Adejare IE, David RA. Surgical Reconstruction of Giant Penoscrotal Lymphedema in Sub-Saharan Africa. Urology. 2018;112:181-185. doi:10.1016/j.urology.2016.09.064.
Modolin M, Mitre AI, da Silva JC, et al. Surgical treatment of lymphedema of the penis and scrotum. Clinics (Sao Paulo). 2006;61(4):289-294. doi:10.1590/s1807-59322006000400003.
Vives F, García-Perdomo HA, Ocampo-Flórez GM. Giant lymphedema of the penis and scrotum: a case report. Autops Case Rep. 2016;6(1):57-61. Published 2016 Mar 30. doi:10.4322/acr.2016.026.
Mukenge S, Pulitanò C, Colombo R, Negrini D, Ferla G. Secondary scrotal lymphedema: a novel microsurgical approach. Microsurgery. 2007;27(8):655-656. doi:10.1002/micr.20426.
Daniel G, Coleman R. Staged rotation flap scrotoplasty and orchidopexy in a patient with inguinal ectopic scrotum. J Surg Case Rep. 2015;2015(10):rjv137. Published 2015 Oct 30. doi:10.1093/jscr/rjv137.
de Souza Filho MV, Girão Rde A, Tomás Filho ME. The challenge of surgical treatment for giant scrotal lymphoedema--the role of local flaps. J Plast Reconstr Aesthet Surg. 2010;63(2):e187-e188. doi:10.1016/j.bjps.2009.01.092.
Wahyudi I, Deswanto IA, Situmorang GR, Rodjani A. One stage rotation flap scrotoplasty and orchidopexy for the correction of ectopic scrotum: A case report. Urol Case Rep. 2019;25:100886. Published 2019 Apr 10. doi:10.1016/j.eucr.2019.100886.

[1] Akan S, Urkmez B, Artuk I, Urkmez A. Scrotal Lymphedema and its Conservative Treatment: A Rare Complication of Circumcision. J Coll Physicians Surg Pak. 2020;30(1):94-95. doi:10.29271/jcpsp.2020.01.94.

[2] Wiryadana, K., Putra, I.W., Rahayu, P.D., Pradnyana, M., Adelaida, M. and Sudarmaja, I. 2018. Risk factors of soil-transmitted helminth infection among elementary school students. Paediatrica Indonesiana. 57, 6 (Jan. 2018), 295-302. DOI:https://doi.org/10.14238/pi57.6.2017.295-302.

[3] Taylor MJ, Hoerauf A, Bockarie M. Lymphatic filariasis and onchocerciasis. Lancet. 2010;376(9747):1175-1185. doi:10.1016/S0140-6736(10)60586-7.

[4] Schook CC, Kulungowski AM, Greene AK, Fishman SJ. Male genital lymphedema: clinical features and management in 25 pediatric patients. J Pediatr Surg. 2014;49(11):1647-1651. doi:10.1016/j.jpedsurg.2014.05.031.

[5] Salako AA, Olabanji JK, Oladele AO, Alabi GH, Adejare IE, David RA. Surgical Reconstruction of Giant Penoscrotal Lymphedema in Sub-Saharan Africa. Urology. 2018;112:181-185. doi:10.1016/j.urology.2016.09.064.

[6] Modolin M, Mitre AI, da Silva JC, et al. Surgical treatment of lymphedema of the penis and scrotum. Clinics (Sao Paulo). 2006;61(4):289-294. doi:10.1590/s1807-59322006000400003.

[7] Vives F, García-Perdomo HA, Ocampo-Flórez GM. Giant lymphedema of the penis and scrotum: a case report. Autops Case Rep. 2016;6(1):57-61. Published 2016 Mar 30. doi:10.4322/acr.2016.026.

[8] Mukenge S, Pulitanò C, Colombo R, Negrini D, Ferla G. Secondary scrotal lymphedema: a novel microsurgical approach. Microsurgery. 2007;27(8):655-656. doi:10.1002/micr.20426.

[9] Daniel G, Coleman R. Staged rotation flap scrotoplasty and orchidopexy in a patient with inguinal ectopic scrotum. J Surg Case Rep. 2015;2015(10):rjv137. Published 2015 Oct 30. doi:10.1093/jscr/rjv137.

[10] de Souza Filho MV, Girão Rde A, Tomás Filho ME. The challenge of surgical treatment for giant scrotal lymphoedema--the role of local flaps. J Plast Reconstr Aesthet Surg. 2010;63(2):e187-e188. doi:10.1016/j.bjps.2009.01.092.

[11] Wahyudi I, Deswanto IA, Situmorang GR, Rodjani A. One stage rotation flap scrotoplasty and orchidopexy for the correction of ectopic scrotum: A case report. Urol Case Rep. 2019;25:100886. Published 2019 Apr 10. doi:10.1016/j.eucr.2019.100886.

A single-stage reconstruction on giant scrotal lymphedema: a case report

Abstract

References

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