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Scrotal oedema in a man who had cystoprostatectomy and ileal diversion 9 years ago

To cite: Chen H-K, Sinagra D, Vivian J. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014206646 DESCRIPTION We report a case of an 88-year-old man who presented to his general practitioner with scrotal oedema. He had a history of diabetes, ischaemic heart disease, congestive heart failure, T1G3 transitional cell carcinoma in his bladder and he was treated with cystoprostatectomy and ileal diversion in 2005. It was thought that the scrotal oedema was associated with his congestive heart failure. However, the symptom worsened despite optimisation of his medical management. This patient later on developed right groin lymphadenopathy which was biopsied and showed metastatic squamous cell carcinoma. Later on it was found by a urologist that the patient had an ulcerative lesion on the urethral meatus which he was unaware of (figure 1). On biopsy, it proved to be squamous cell carcinoma, and bone scan showed extensive metastasis to the right groin lymph nodes, resulting in scrotal lymphoedema (figure 2). One may wonder why this significant penile lesion had not been detected until this late stage. The explanation is that the patient described in this case had cystoprostatectomy and ileal diversion in 2005 and he had not voided through his penis since. As a result, the patient did not notice the penile ulcer under the foreskin and failed to report this to his general practitioner. Learning points