Abstract
Spontaneous scrotal enterocutaneous fistulas (ECFs) are rare. They are more common in countries with poor access to medical care. Based on our literature search, our patients represent the first two reported adult cases of scrotal ECFs in the United States.
Both patients were incidentally 83-year-old males who presented from assisted living facilities with past medical histories of prostate cancer, for which one received brachytherapy. One patient was an adult male who noted scrotal swelling with clear drainage from his right scrotum for one month and presented to the emergency department when he saw stool draining from his scrotum. The second patient also presented to the emergency department when he noted stool draining from his left scrotum; of note he had a known left inguinal hernia that was easily reducible two weeks prior to presentation. In the operating room, both patients were diagnosed with incarcerated hernias. The first patient had an ECF from his cecum to right scrotum and the second patient had an ECF from his sigmoid colon to left scrotum. The fistulae allowed for bowel decompression of the patients’ incarcerated inguinal hernias.
To our knowledge, these are the first recorded cases describing spontaneous scrotal ECFs in adults in the U.S. They are also the seventh and eighth reported cases worldwide. Both patients likely had delayed presentations of their incarcerated hernias because their scrotal ECFs decompressed their incarcerated bowels and attenuated the development of obstructive symptoms. Each patient ultimately underwent a successful orchiectomy by urology, as well as bowel resection with ligation of their scrotal ECFs, and herniorrhaphy by general surgery.
Keywords
Enterocutaneous fistula, Fistula, Spontaneous fistula