Case Report

Lymphoedema of
the Penis and
Scrotum as a
Sequela of Chronic
Skin Infection
Journal Reading
Pembimbing: dr. Yopi Budiman, Sp. B
Penyusun: Fidel Laurens 112022235

Kepaniteraan Klinik Ilmu Bedah

Periode 15 Januari - 23 Maret 2024
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Background

Lymphoedema is an abnormal Obstruction of the lymphatic Acquired penis lymphoedema

lymphatic fluid retention drainage system may lead to is not common in clinical
condition secondary lymphoedema practices
 Case Presentation
- In 2010, he recognized a small area of
induration with purulent discharge on
his scrotum
- His scrotum and penis had swollen
gradually without pain
- He can urinate normally despite the
penile enormity
- The patient kept no pets, no particular
record of travelling abroad, no record of
neoplasm, trauma, surgery, or
Age: 48 years irradiation
- The patient denied familial presence of
Gender: Male
any similar condition
BMI: 34.5
Allergies: None
Location: Japan
Physical
Examination

Inspection Palpation
- The swollen penis was distorted - Enlarged lymph nodes were
rightward palpable in the bilateral
- inguinal regions
The glands and external urethral
orifice could not be identified
- The skin was thick and rough,
several dimples with purulent
discharge were seen
 Laboratory Results

WBC count 16120 /ul, C-reactive

01 protein 3.9 mg/dl. No sign of
Ancillary immunocompromise

Examination 02
Methicillin-sensitive S. aureus, Prevotella
oralis, and Peptostreptococcus
asaccharolyticus were positive in the
purulent discharge

DNA detection for Chlamydia

03 trachomatis was negative in both
urine and abscess discharge
Case Presentation
- The final diagnosis was Lymphoedema of the penis ec Chronic Skin Infection
- Bilateral inguinal dissection of the superficial lymph nodes was performed
- The scrotal skin was also excised above the cremasteric fascia
- The resected specimen measured 25 × 30 × 20 cm and weighed 3.6 kg
- The degloved penile shaft and scrotum were covered with skin grafts, and a
satisfactory result was obtained
Discussion
- Lymphoedema is a condition involving the chronic collection of lymphatic
fluid. Acquired obstruction of the lymphatic system may cause secondary
Lymphoedema.
- In this report, we presented a case with an enormous lymphoedematous
condition of the penis and scrotum
- Resident inhabitant bacteria were detected in the purulent discharge, and we
concluded that chronic local infection, or hidradenitis suppurativa, developed
into obstruction of the lymphatic flow.
- There are two lymphatic systems in penis: the superficial system and the
deep system. The superficial system drains the prepuce and skin of the
penis, and it flows into the superome- dial zone of the superficial inguinal
nodes. The deep system drains the glans, runs beneath the deep fascia and
flows both directly into the pelvic nodes and to the superficial inguinal
nodes.
Conclusion
- Obstruction of the lymphatic system may lead to secondary
Lymphoedema
- Lymphadematous condition of the penis and scrotum is a quite rare
case
- Chronic infection may develop a lymphatic flow obstruction
- Conservatives remedies was suggested, but the definitive therapy is
wide surgical excision