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CROHN'S DISEASE AND MALE GENITOURINARY SYSTEM
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is a practicing gastroenterologist and author of
"Natural Stomach Care: Treating and Preventing Digestive Disorders with
Best of Eastern and Western Therapies".
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Involvement of male genitalia by Crohn's disease is rare. It may occur as a result of extension of a fistula from the
diseased bowel or may represent spread (metastatic) of Crohn's disease to distant sites.
The penis, scrotum, seminal vesicles and prostate have been recorded to be the sites of
involvement. We recently had an unusual case who did not have any overlying skin
involvement and the diagnosis was based on the CT scan.
- Our case: Our patient is a 48 year
old white male with history of Crohn's disease involving small intestine and colon. He was
seen in ER for abscesses in the rectal region. A soft cystic mass was noted in the scrotum. Clear serous material discharge
from from the penis. CT scan showed an abscess around rectum which extended into the
penis, seminal vesicles and scrotum. A urethrogram revealed a fistulous tract extending
into the scrotum. The patient was treated with antibiotics. A surgical repair of the
fistula was recommended.
Some patients develop ulceration of
scrotum and/or spontaneous perineal urethral fistulae. Formation of a fistula extending
from the anal canal to the root of scrotum and the penis may result in "watering
can" appearance of scrotum during micturition, i.e. During urination, the urine comes
out through openings in the scrotum.
- Depending on symptoms, the patient
may first see their primary physician, a gastroenterologist or dermatologist.
There may be gross swelling
and ulceration's of the scrotum and penis. Total involvement of the
skin of the scrotum and penis may lead to the erroneous conclusion that it
represents severe but transient edema caused by neighboring perianal abscesses and fistulae. Thickening of the
prepuce may result in narrowing of the foreskin.
- The diagnosis is generally made by
clinical features. Imaging studies including CT scan, gallium scan, ultrasound and
magnetic resonance imaging may serve as valuable adjuncts. X-ray of urethra after filling
it with a dye is diagnostic for urethral fistula. Differential diagnosis of the
genitourinary lesions includes syphilis, herpes simplex, hidradenitis suppurativa,
tuberculosis, actinomycosis, lymphogranuloma venereum, leishmaniasis, chancroid, Bechet's
syndrome and filariasis.
Treatment is controversial.
Metronidazole and prednisone have been inconsistently shown to be of benefit. Azathioprine
and 6-mercaptopurine are frequently used. Other treatments including diuretics, ascorbic
acid or zinc supplements have been tried. Scrotal support may alleviate scrotal edema.
Relapse may occur when medical treatment is withdrawn.
bowel. Regular curettage and extensive excision of the perineal, penile and scrotal skin may be needed. Phimosis may require circumcision.
Spontaneous healing of metastatic Crohn's disease ulcers has been reported.
Above information is based
on the following article
MINOCHA et al. : Crohn's Disease Complicating Male Genitourinary Tract Without
Overlying Cutaneous Involvement. American Journal of Gastroenterology 1996.
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crohn, crohn's, herpes simplex,
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