Massive Scrotal Lymphedema in an Adolescent with Intellectual Disability: A Rare Case of Infection-Related Scrotal Enlargement Requiring Subtotal Scrotectomy

Abstract

An uncommon disorder marked by aberrant fluid accumulation brought on by lymphatic blockage, scrotal lymphedema presents major functional, cosmetic, and hygiene problems. It can be acquired or congenital; the most often occurring causes are infection, persistent inflammation, and filariasis. This case report describes a 17-year-old male patient with intellectual disability who had severe scrotal lymphedema that gradually developed over four years, causing problems with ambulation and hygienic care. Under a clinical examination, the scrotum (40 x 15 cm) was swollen and expanded, hiding the penis but having palpable testes. Ultrasound verified without testicular involvement scrotal wall thickening. After a subtotal scrotectomy preserves the testes, penis, and spermatic cord, scrotal reconstruction was done considering the functional limitation. Chronic inflammatory alterations without filarial organisms revealed by histopathology suggested an etiology connected to infections. The patient healed postoperatively with better mobility and hygienic standards. This example emphasizes the need for early identification and surgical intervention in controlling large scrotal lymphedema to maximize functional and cosmetic results.

Keywords: chronic inflammation; hypertrophy; infection-related lymphedema; reconstruction; scrotal lymphedema.

Figure 1. Preoperative image of massive scrotal lymphedema in an adolescent with intellectual disability, showing extensive scrotal enlargement and distorted anatomy due to chronic infection-related lymphedema.

Figure 2. Ultrasound images of the affected scrotal region

(A) Diffuse hyperechoic areas indicating chronic inflammatory changes and fibrosis; (B) Fluid collection and edema suggestive of longstanding lymphedema. These findings correlate with the clinical and histopathological features of infection-related lymphedema.

Figure 3. Postoperative image following subtotal scrotectomy, demonstrating partial reconstruction with preserved penile structures and a drain in place for fluid management.

Figure 4. Histopathology image showing chronic inflammatory changes with fibrosis and lymphatic dilation, consistent with infection-related lymphedema.

Figure 5. Higher magnification histopathology image demonstrating dense inflammatory infiltrate with no evidence of filarial organisms, confirming the non-parasitic nature of the condition.