We report the case of a 47-year-old man who presented with a 5-year history of lymphedema and giant fever of unknown origin.
The most important antecedents were right inguinal hernioplasty 5 years ago, as well as chronic liver disease B due to pancreatitis and ascites.
The patient had no history of pelvic radiotherapy or travel abroad that could explain filariasis.
Examination revealed the presence of a mass and an important size with signs of lymphadenomatous skin, in which scrotum could be intuited without the presence of penis.
The patient was continent and referred to as having small holes in the anterior region of the mass.
He also had suppurative ulcers.
A rectal examination revealed a small, bilobulated prostate with no nodules. Laboratory tests showed normal renal function, normal PSA and negative urine culture.
A magnetic resonance imaging (MRI) was performed on the neck, showing a large lymphedema and abscess formation of 6 cm in the right inguinal canal, as well as the presence of several bilateral active inguinal lymphadenopathies.
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The penis and both testicles were first identified through a suprapubic incision.
Given the non-viability of the right testicle, a simple right orchiectomy was performed and all the affected cutaneous and subcutaneous tissue was resected until reaching healthy tissue, after which two flaps were performed: superior and posterior to cover.
We performed an incision at the pubis level through which the penis was extracted and used a penile cutaneous self-injection to cover the cutaneous deficit of the penis.
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The postoperative period was uneventful and the patient was discharged 7 days after surgery.
The anatomopathological study of the resection specimen confirmed that the microscopic aspect of the sample was compatible with chronic lymphedema.
The evolution was favorable except for a small piece of healing wound (with granulation tissue) and partial loss of penile grafts, without signs of infection of the wounds, which was decided to treat with a second intention
One month later, the patient had no signs of dementia and the tissue in the penis was completely reepithelialized.
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After a 9-month postoperative follow-up, the patient presented a good evolution and an improvement in his quality of life, with a clear improvement in hygiene (the constant mobility and the problem presented by his work impossibility); his life had started again.
As only alteration we must refer to a preputial remnant that during its postoperative follow-up presents mild edema but which has improved.
