Unusual association of ectopic scrotum with anal stenosis: a case report

Abstract

Congenital anomalies of the scrotum are rare and include penoscrotal transposition, bifid scrotum, ectopic scrotum, and accessory scrotum. Suprainguinal ectopic scrotum is characterized by the abnormal location of a hemiscrotum outside its usual position and is frequently associated with other congenital anomalies. We report a male infant with left suprainguinal ectopic scrotum associated with anal stenosis, an association not previously described. A term male born by repeat caesarean section presented with a left hemiscrotum located in the ipsilateral inguinal region, harboring a palpable testis. Anal stenosis and a sacrococcygeal pit were also noted. Work‑up included lumbosacral MRI, which excluded spinal cord anomalies. The patient underwent a sigmoid colostomy, followed by a limited posterior sagittal anorectoplasty, and subsequently underwent colostomy closure. At 18 months, one-stage scrotoplasty with a random-pattern transposition flap and left orchidopexy were performed jointly by the pediatric urology and plastic surgery teams. Postoperative follow-up at 21 months demonstrated an orthotopic, well-vascularized scrotum with viable testes. Ectopic scrotum results from defective development of the gubernaculum and labioscrotal swellings. Its concurrence with anorectal malformations suggests a broader mesodermal defect. Early, individualized, multidisciplinary management is essential. Our case is, to our knowledge, the first report of ectopic scrotum associated with isolated anal stenosis. Timely diagnosis and coordinated surgical management can restore normal anatomy and function with excellent aesthetic outcomes. Awareness of possible associated anomalies is crucial for comprehensive evaluation.