Foreign Body Reaction to Bovine Pericardium: A Previously Unreported Complication of Pediatric Chordee Repair

Abstract

Patching the shortened aspect of the corpora cavernosa is an established method of correcting penile curvature. Pericardium has been successfully used as an off-the-shelf material for tunica albuginea patching in the correction of Peyronie’s disease.1 While this technique is also applicable to the repair of congenital penile chordee, there is relatively little experience with its use in the pediatric population. We report a novel case of foreign body reaction to bovine pericardium in the penis that initially presented as a postoperative penile mass. CASE REPORT A 12-month-old boy underwent operative repair of a 30degree right lateral congenital chordee of the penis. Persistent curvature after complete degloving of the penile skin signified intrinsic corporal disproportion. To avoid penile shortening by plication we elected to graft the shorter concave aspect of the penile shaft. After urethral mobilization, the tunica albuginea of the right corpus cavernosum was incised, allowing straightening of the penis. The resultant defect was repaired with a 9 15 mm. elliptical patch of bovine pericardium (Periguard, Bio-Vascular, Inc., St. Paul, Minnesota). The patch was secured with 5-zero synthetic absorbable monofilament suture. Erectile function was well preserved as demonstrated by spontaneous straight erections postoperatively. A painless subcutaneous nodule was noted on the right side of the penile shaft 11 weeks later (fig. 1, A). No systemic reactions were evident, and observation was elected initially. However, the nodule failed to resolve during the next 6 months and, thus, prompted surgical exploration. The area of the previously placed pericardial graft was found to be occupied by a 1 cm. yellow mass (fig. 1, B). The mass was excised, leaving a defect in the tunica albuginea that was patched with an autologous dermal graft. Pathological evaluation of the lesion revealed xanthogranulomatous reaction, including foamy macrophages, chronic inflammation and foreign body giant cells (fig. 2). To date the cosmetic effect remains excellent, with continued straight spontaneous erections and no recurrence of the mass. DISCUSSION