Genitourinary Trauma: A Video Series

Basil O Zakkar, Michael S Tawfik, Zeeshan Zubair, Omer A Raheem

Genital Crohn's disease, metastatic Crohn's disease, enlarged circumcision surgery, sexual dysfunction, preputial lymphedema

Genital manifestations of Crohn's disease, though rare and often referred to as Metastatic Crohn's disease [1], can present as lymphedema of the external genitalia with granulomatous lesions (Genital Granulomatosis) [2]. While extraintestinal skin involvement is reported in 22–75% of Crohn’s cases [3], severe manifestations may require surgical intervention when medical treatments fail [4]. This report details the case of a 19-year-old male with penile Crohn's disease characterized by pain, sexual dysfunction, and lymphedema affecting the preputial skin and distal penile shaft, unresponsive to antibiotics and corticosteroids but managed with Ustekinumab and Vedolizumab. Preoperative MRI revealed circumferential tissue thickening and inflammation indicative of disease progression. The patient underwent an enlarged circumcision, involving precise excision of diseased tissue with intraoperative verification of healthy margins through hydraulic erection. Histological examination of the excised preputial nodule confirmed granulomatous lymphoid infiltration, consistent with Metastatic Crohn's disease. The penile skin was reattached using absorbable sutures, and a catheter was placed to prevent urinary complications. The surgery was successful, with no postoperative complications, proper wound healing, and resolution of pain and sexual dysfunction. This case highlights that surgical excision, such as enlarged circumcision, can be an effective treatment for genital Crohn's disease when conservative measures are insufficient, providing symptom relief and restoring function

None.

The authors have nothing to disclose