Scrotoschisis: a case report
Sidibe et al. Journal of Medical Case Reports
Scrotoschisis: a case report
Souleymane Sidibe 1 3
Maxime Coulibaly 2
Salman Ghazwani 0
0 Jazan University , P.O. Box 114, Jazan Postal Code 45 142 , Saudi Arabia
1 Department of Pediatric Surgery, Tambacounda Regional Hospital , Tambacounda , Senegal
2 Department of Anaesthesia, Tambacounda Regional Hospital , Tambacounda , Senegal
3 Department of General Surgery, Tambacounda Regional Hospital , Tambacounda , Senegal
Background: Scrotoschisis is a rare congenital anomaly of the scrotal wall with idiopathic etiology and unknown prevalence. This pathology is extremely rare. We report a new case and review the literature for relevant data. Case presentation: A 3-day-old full-term baby boy of African ethnicity, who had a homebirth, with birth weight of 2.7 kg presented to our emergency department with exteriorization of left testis; after clinical examination and proper investigations the diagnosis was scrotoschisis. Surgical treatment was performed by primary closure with excellent follow-up. We reviewed the literature to elaborate on the etiology of this pathology and its management. Conclusions: Scrotoschisis is a rare congenital anomaly affecting healthy babies. Early management is substantial. Further studies are recommended to learn more about the etiology and long-term results, including the effect on the fertility.
Testicular exstrophy; Scrotal wall abnormality; Orchidopexy
A 3-day full-term baby boy of African ethnicity presented
to our emergency department with exteriorization of left
testis from his left hemi-scrotum. He was born at home at
41 weeks of gestational age by normal vaginal delivery:
birth weight. 2.7 kg, birth length of 44 cm, and head
circumference of 46 cm. His 27-year-old mother,
primigravida, is a farmer without a particular past or medical
history: there is no family history of the same pathology
and no history of consanguinity. An examination revealed
no relevant findings for his other organs. There was
neither antenatal nor ultrasonography follow-up. A physical
examination was remarkable for left scrotal anterior wall
defect of 1.5 × 2 cm with normal aspect of inguino-genital
region. His left testis was exteriorized within its coverage
of tunica vaginalis, mildly edematous with a thin fine
exudative inflammatory membrane but with normal
vascular appearance. All blood analyses and urine
examinations were within normal range. Broad-spectrum antibiotics
(ceftriaxone) were started on his arrival at our emergency
unit. Under general anesthesia, surgical debridement and
scrotal defect exploration showed complete left
scrotoschisis with free and mobile extracorporeal testis,
no calcified masses, and no meconium residua (Fig. 1).
Orchidopexy and primary skin closure was performed
horizontally in two layers with vicryl 4-0. There were good
results on follow-up at 1 and 2 months. Testicular
ultrasound at 3 months showed two identical testes with
normal appearance; there was no follow-up beyond 3 months.
Scrotoschisis is a rare congenital scrotal wall pathology.
Its prevalence is unknown. Only 16 cases were reported
in the literature [
]. It is a semi-urgent condition
which should be managed immediately if it presents with
a testicular torsion. There are many hypotheses for its
etiology: Failure of differentiation of scrotal mesenchyme
layer results in rupture or avascular necrosis of overlying
epithelium leading to scrotal wall defect . Other
reports mentioned external mechanical compression
effect due to arthrogryposis [
], as well as meconium
]. In our case, we have no obvious cause;
there is no evidence of meconium residua and neither is
there evidence of traumatism. Iatrogenic injury is a
potential cause and could be concurrently associated if
obstetrical difficulties were encountered during labor,
mostly if completed by cesarean section [
Broadspectrum antibiotics should be commenced immediately
on diagnosis. During a physical examination, it is
fundamental to rule out testicular torsion (due to lack of
testicular anatomical attachments). A local aseptic dressing
procedure is imperative to avoid possible orchitis or
peritonitis in case of communicating patent processus
vaginalis. A surgical approach depends on the severity
and could be a simple dressing with healing by
secondary intention [
] or conventional surgical method in two
planes horizontally or vertically after orchidopexy. In
our case, we preferred to close in two layers horizontally;
the skin defect was mainly horizontal. Postoperative
follow-up should not be discontinued until verification
of two symmetric, vital, and normally growing testes.
Further research is recommended to study the effect of
scrotoschisis on fertility.
Scrotoschisis is a rare congenital anomaly affecting
otherwise healthy babies. Early management is substantial.
Further studies are recommended to learn more about the
etiology and long-term results, including fertility.
Availability of data and materials
No data sets were generated or analyzed during this study.
SS managed the case, collected and evaluated the data; MC assisted in managing
the case and did the first draft of manuscript; SG received and critically revised the
manuscript and coordinated the submission; and all authors read and approved
the final manuscript.
Ethics approval and consent to participate
Consent for publication
Written informed consent was obtained from the patient’s legal guardians for
publication of this case report and any accompanying images. A copy of the
written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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