Abstract
Scrotal necrosis is a rare occurrence that is scarcely reported among patients having undergone heated intra-peritoneal chemotherapy (HIPEC) procedures. Due to anatomic factors and the thermally enhanced cytotoxicity of chemotherapeutic agents, this complication can have debilitating post-operative effects. We herein highlight the presentation of scrotal necrosis in a patient who underwent HIPEC procedure for peritoneal metastasis secondary to colorectal carcinoma, and how it contrasts to previously documented cases of a similar nature. Furthermore, we describe a successful management strategy that consisted of conservative measures followed by surgical debridement and primary repair, and enabled the patient to experience significant functional and cosmetic improvement.
Highlights
Heated intra-peritoneal chemotherapy (HIPEC) is utilized in the management of disseminated intraabdominal malignancies, such as colorectal [1], ovarian [2], appendiceal [3], and primary peritoneal neoplasms
Mitomycin C (MMC) is linked to side effects such as neutropenia (40%) [7], respiratory complications (17%), intraabdominal collections (8.8%), anastomotic leaks (4.4%), wound infections (7.2%), ileus (6.2%), and acute renal injury (5.6%) [8]
A few recorded cases have been described in the literature [9,10,11,12,13]
Summary
Heated intra-peritoneal chemotherapy (HIPEC) is utilized in the management of disseminated intraabdominal malignancies, such as colorectal [1], ovarian [2], appendiceal [3], and primary peritoneal neoplasms. Subsequent surveillance imaging revealed suspicious peritoneal deposits confirmed to be malignant through diagnostic laparoscopy and peritoneal biopsy He underwent CRS including low anterior resection for a large infiltrative pelvic deposit, seminal vesicles resection, and peritonectomy along with MMC-based HIPEC. On post-operative day 30, he began to develop scrotal swelling and discoloration in the form of diffuse erythema with black spots (Figure 1, panel a). He was seen by the urology team, who recommended watchful waiting.
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